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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique ","code_information":[{"code":"45315","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique ","code_information":[{"code":"45315","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth 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Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique ","code_information":[{"code":"360","type":"RC"},{"code":"45309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Proctosigmoidoscopy, rigid; with transendoscopic stent placement (includes predilation) ","code_information":[{"code":"45327","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; clavicle ","code_information":[{"code":"23490","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case 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 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","plan_name":"HIX","standard_charge_dollar":11411.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case 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":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; ulna ","code_information":[{"code":"25491","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; ulna ","code_information":[{"code":"25491","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Prophylactic treatment (nailing, pinning, plating or wiring), with or without methylmethacrylate, humeral shaft ","code_information":[{"code":"24498","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case 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billable gross charges.","estimated_amount":115.87,"methodology":"percent of total billed charges"}]}]},{"description":"Prostate cancer screening; prostate specific antigen test (psa) ","code_information":[{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19.12,"maximum":28.96,"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":19.89,"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 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Prostatotomy, external drainage of prostatic abscess, any approach; complicated ","code_information":[{"code":"481","type":"RC"},{"code":"55725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Prostatotomy, external drainage of prostatic abscess, any approach; simple ","code_information":[{"code":"481","type":"RC"},{"code":"55720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"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":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun 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","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":86.25,"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":16.57,"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":14.93,"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":37.50,"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":12.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":6.97,"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":17.25,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":15.75,"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":25.50,"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":17.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":14.25,"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":63.75,"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":56.25,"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":6.97,"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":9.75,"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":37.50,"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":60.00,"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":63.75,"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":37.50,"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":10.13,"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":108.75,"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":21.38,"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":33.75,"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":18.98,"methodology":"percent of total billed charges"}]}]},{"description":"Push transfusion, blood, 2 years or younger ","code_information":[{"code":"360","type":"RC"},{"code":"36440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Pyruvate ","code_information":[{"code":"156689","type":"CDM"},{"code":"84210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.34,"maximum":21.72,"gross_charge":229.00,"discounted_cash":229.00,"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":14.91,"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":9.80,"standard_charge_algorithm":"Reimbursement will be 9.8% of billable gross 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","code_information":[{"code":"369","type":"RC"},{"code":"65771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Radial keratotomy 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","code_information":[{"code":"156692","type":"CDM"},{"code":"84233","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87.00,"maximum":131.82,"gross_charge":2269.00,"discounted_cash":2269.00,"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":90.52,"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":9.80,"standard_charge_algorithm":"Reimbursement will be 9.8% of billable gross 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"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"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. 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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":1145.50,"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":1832.80,"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":1947.35,"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":1145.50,"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":652.93,"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":1030.95,"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":579.62,"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":"360","type":"RC"},{"code":"50382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation ","code_information":[{"code":"360","type":"RC"},{"code":"50384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7427.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"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":34707.00,"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":12056.00,"methodology":"case 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":34707.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":25527.00,"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":"481","type":"RC"},{"code":"54411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":34707.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"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":34707.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":25527.00,"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":"490","type":"RC"},{"code":"54411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":34707.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case 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":34707.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":25527.00,"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":"54411","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":34707.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case 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":34707.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":25527.00,"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":"54411","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":34707.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"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":34707.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":25527.00,"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":"360","type":"RC"},{"code":"53447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":21894.00,"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":12056.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":21894.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15643.00,"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":"360","type":"RC"},{"code":"53448","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"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":"361","type":"RC"},{"code":"54416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":34707.00,"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":12056.00,"methodology":"case 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":34707.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":25527.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of permanent cardiac contractility modulation system pulse generator only ","code_information":[{"code":"0414T","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":14099.00,"maximum":79646.00,"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":79646.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":56311.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from deep penile tissue (eg, plastic implant) ","code_information":[{"code":"490","type":"RC"},{"code":"54115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from deep penile tissue (eg, plastic implant) ","code_information":[{"code":"54115","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from deep penile tissue (eg, plastic implant) ","code_information":[{"code":"54115","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from external auditory canal; with general anesthesia ","code_information":[{"code":"361","type":"RC"},{"code":"69205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from external auditory canal; with general anesthesia ","code_information":[{"code":"499","type":"RC"},{"code":"69205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from external auditory canal; without general anesthesia ","code_information":[{"code":"369","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from external auditory canal; without general anesthesia ","code_information":[{"code":"481","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from external auditory canal; without general anesthesia ","code_information":[{"code":"490","type":"RC"},{"code":"69200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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","code_information":[{"code":"30320","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Removal 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"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":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Removal of entire lumbosubarachnoid shunt system without replacement ","code_information":[{"code":"361","type":"RC"},{"code":"63746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health 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rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; deep ","code_information":[{"code":"21925","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; deep ","code_information":[{"code":"21925","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular) ","code_information":[{"code":"25066","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"25065","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; superficial ","code_information":[{"code":"27613","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of neck or thorax ","code_information":[{"code":"21550","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of pelvis and hip area; superficial ","code_information":[{"code":"27040","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of thigh or knee area; superficial ","code_information":[{"code":"27323","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of upper arm or elbow area; superficial ","code_information":[{"code":"24065","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vestibule of mouth ","code_information":[{"code":"40808","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vestibule of mouth ","code_information":[{"code":"40808","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Biopsy; nasopharynx, visible lesion, simple ","code_information":[{"code":"360","type":"RC"},{"code":"42804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Biopsy; nasopharynx, visible lesion, simple ","code_information":[{"code":"42804","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"BIT DRILL 1.7MM CANNULAT ","code_information":[{"code":"857768","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4913.00,"discounted_cash":4913.00,"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":810.64,"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":368.48,"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":938.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 13.8% of billable gross charges.","estimated_amount":677.99,"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 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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":219.12,"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":129.48,"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":498.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":268.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":268.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":268.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":236.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":130.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":105.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":72.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":68.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":172.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":236.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":172.31,"methodology":"percent of total billed charges"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":348.60,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":129.48,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":1145.40,"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":220.12,"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":198.20,"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":498.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom 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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":338.64,"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":229.08,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":268.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":189.24,"methodology":"percent of total billed 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"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"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. 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","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":966.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":913.84,"methodology":"percent of total billed charges"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":4635.40,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1721.72,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health 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$4200.","estimated_amount":1787.94,"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":19203.80,"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":5959.80,"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":3350.73,"methodology":"percent of total billed charges"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate 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logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), ea ","code_information":[{"code":"31651","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":13320.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"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":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), ea ","code_information":[{"code":"31651","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":13320.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"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":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance (eg, fibrin glue), if ","code_information":[{"code":"31634","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case 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procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage ","code_information":[{"code":"31624","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case 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procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspirationºs»/biopsyºies ","code_information":[{"code":"31653","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case 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","code_information":[{"code":"31648","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13320.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"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":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initial ","code_information":[{"code":"31645","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further 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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":630.96,"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":372.84,"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":1434.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":774.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":774.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":774.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":679.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":375.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":304.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":209.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":197.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":496.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":679.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":496.16,"methodology":"percent of total billed charges"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":1003.80,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":372.84,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":3298.20,"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":633.83,"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":570.73,"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":1434.00,"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":458.88,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":266.72,"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":659.64,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":602.28,"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":975.12,"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":659.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":774.36,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":544.92,"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":2437.80,"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":2151.00,"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":266.72,"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":372.84,"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":1434.00,"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":2294.40,"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":2437.80,"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":1434.00,"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":387.18,"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":4158.60,"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":817.38,"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":1290.60,"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":725.60,"methodology":"percent of total billed charges"}]}]},{"description":"Capsular contracture release (eg, Sever type procedure) ","code_information":[{"code":"23020","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Capsular contracture release (eg, Sever type procedure) ","code_information":[{"code":"23020","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Capsular contracture release (eg, Sever type procedure) ","code_information":[{"code":"23020","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint ","code_information":[{"code":"26520","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Capsulodesis, metacarpophalangeal joint; 2 digits ","code_information":[{"code":"26517","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case 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further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Capsulodesis, metacarpophalangeal joint; 2 digits ","code_information":[{"code":"26517","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Capsulodesis, metacarpophalangeal joint; 2 digits ","code_information":[{"code":"26517","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy, anterior, any type; with coracoid process transfer ","code_information":[{"code":"23462","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy, anterior, any type; with coracoid process transfer ","code_information":[{"code":"23462","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy, anterior; with labral repair (eg, Bankart procedure) ","code_information":[{"code":"23455","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case 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":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy, anterior; with labral repair (eg, Bankart procedure) ","code_information":[{"code":"23455","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"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":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case 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Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":443.00,"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":119.61,"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":1284.70,"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":252.51,"methodology":"percent of total billed 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logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, acromioclavicular, sternoclavicular joint, including exploration, drainage, or removal of foreign body ","code_information":[{"code":"23044","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth 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dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Arthrotomy, distal radioulnar joint including repair of triangular cartilage, complex ","code_information":[{"code":"25107","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom 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Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Curettage, postpartum ","code_information":[{"code":"360","type":"RC"},{"code":"59160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"CURETTE CRVD 11MM ","code_information":[{"code":"925794","type":"CDM"}],"standard_charges":[{"setting":"outpatient","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":13.80,"standard_charge_algorithm":"Reimbursement will be 13.8% of billable gross charges.","estimated_amount":31.60,"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":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":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":61.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":61.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":61.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":61.83,"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":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":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":61.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":61.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":61.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":54.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":30.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":24.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":16.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":15.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":39.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":54.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":39.62,"methodology":"percent of total billed charges"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":80.15,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","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":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":263.35,"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":"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":"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":"Freedom Health","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":"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":"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":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":61.83,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":43.51,"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":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":"Cutaneous vesicostomy ","code_information":[{"code":"481","type":"RC"},{"code":"51980","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Cutaneous vesicostomy ","code_information":[{"code":"490","type":"RC"},{"code":"51980","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","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":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"CUTTER ARTHSCP 3.5X125MM ","code_information":[{"code":"801253","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2752.00,"discounted_cash":2752.00,"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":454.08,"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":206.40,"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":525.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 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","code_information":[{"code":"360","type":"RC"},{"code":"51520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Cystotomy; for simple excision of vesical neck (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"51520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique) ","code_information":[{"code":"499","type":"RC"},{"code":"52325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case 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rate"},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus ","code_information":[{"code":"52320","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":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"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 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dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Cystourethroscopy (separate procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"52000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"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 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Cystourethroscopy, with insertion of permanent urethral stent ","code_information":[{"code":"369","type":"RC"},{"code":"52282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"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: 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","code_information":[{"code":"27696","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, disrupted ligament, ankle; collateral ","code_information":[{"code":"27695","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health 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","code_information":[{"code":"27405","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"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":4296.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"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":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"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":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"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":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"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":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case 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":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon ","code_information":[{"code":"28200","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"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":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"361","type":"RC"},{"code":"49452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"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":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"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":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Replacement of tissue expander with permanent implant ","code_information":[{"code":"11970","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Replacement of tissue expander with permanent implant ","code_information":[{"code":"11970","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Replacement or irrigation, subarachnoid/subdural catheter ","code_information":[{"code":"62194","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"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":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"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":2702.00,"maximum":11560.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Replacement or revision of cerebrospinal fluid shunt, obstructed valve, or distal catheter in shunt system ","code_information":[{"code":"499","type":"RC"},{"code":"62230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":11560.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access ","code_information":[{"code":"36582","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_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"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":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":11054.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8515.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7008.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8712.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":11054.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8712.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8980.00,"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":"HIX","standard_charge_dollar":8010.00,"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 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"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":9747.02,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":10298.74,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":9563.11,"methodology":"fee schedule"},{"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":9011.39,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8919.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Trustbridge Hospice","plan_name":"COMM","standard_charge_dollar":650.00,"methodology":"per diem"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"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":20148.40,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":18585.42,"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":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"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":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":19126.75,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":27037.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13709.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10835.45,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":18224.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18224.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14817.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27037.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14817.19,"methodology":"fee schedule"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":17629.59,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":18946.31,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":18044.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19848.51,"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":18765.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18404.98,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":19307.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19126.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":19126.75,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":20209.39,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":18765.86,"methodology":"fee schedule"},{"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":17683.22,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17502.78,"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":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19126.75,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1175.00,"methodology":"case rate"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1175.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":18946.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":19126.75,"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":22555.13,"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":18946.31,"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":18765.86,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":18946.31,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":109.00,"standard_charge_algorithm":"Reimbursement will be 109% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":19848.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19126.75,"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":"Trustbridge Hospice","plan_name":"COMM","standard_charge_dollar":650.00,"methodology":"per diem"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7851 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":18044.10,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":17196.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5605.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $6331 per diem instead of the contracted rate."},{"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":18044.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17502.78,"methodology":"fee schedule"}]}]},{"description":"RETRCTR WND LG 9-14CM ","code_information":[{"code":"823227","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4487.00,"discounted_cash":4487.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross 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charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":19313.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":5221.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":4935.57,"methodology":"percent of total billed charges"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":25035.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health 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Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":6652.29,"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":16451.90,"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":16451.90,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":19313.10,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":13590.70,"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":60800.50,"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":53647.50,"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":6652.29,"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":35765.00,"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":57224.00,"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":60800.50,"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":35765.00,"methodology":"percent of total billed 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","code_information":[{"code":"360","type":"RC"},{"code":"37226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":21936.00,"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":10567.00,"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 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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":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"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":"369","type":"RC"},{"code":"37231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":27039.00,"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":12056.00,"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":27039.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":19320.00,"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":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":21936.00,"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":12056.00,"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":17422.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13473.00,"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 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","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":12256.70,"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":5329.00,"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":1705.28,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":991.19,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health 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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":15454.10,"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":4796.10,"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":2696.47,"methodology":"percent of total billed charges"}]}]},{"description":"Revision (including removal) of prosthetic vaginal graft, laparoscopic approach 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logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"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":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright 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","code_information":[{"code":"19370","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case 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","code_information":[{"code":"490","type":"RC"},{"code":"57230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"PLATE 20MM TRULKSUP EXFX ","code_information":[{"code":"824505","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5500.00,"discounted_cash":5500.00,"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":907.50,"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":412.50,"methodology":"percent of total billed 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charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.00,"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":1210.00,"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":715.00,"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":2750.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":1303.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":720.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":583.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":401.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":379.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":951.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":1303.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":951.50,"methodology":"percent of total billed charges"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":1925.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":715.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health 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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":1870.00,"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":1265.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1045.00,"methodology":"percent of total billed 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"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3945.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":34933.33,"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":"AvMed","plan_name":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":35950.80,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":14505.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25224.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":27407.00,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":34255.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":34255.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":42039.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":14505.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":42039.00,"methodology":"case rate"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":35611.64,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":33915.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":37307.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":35272.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":34594.17,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":36289.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":35950.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 13. 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"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":35950.80,"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":42394.81,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":35611.64,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement 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may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) ","code_information":[{"code":"45317","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"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":"790","type":"RC"},{"code":"93464","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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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":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"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":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (List separately in additi ","code_information":[{"code":"19282","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (List separately in additi ","code_information":[{"code":"19282","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"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":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"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":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"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":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"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":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"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":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"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":"360","type":"RC"},{"code":"49411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"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":"49411","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"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":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"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":"360","type":"RC"},{"code":"55876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"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":"499","type":"RC"},{"code":"55876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"0347T","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Placement of needles or catheters into muscle and/or soft tissue for subsequent interstitial radioelement application (at the time of or subsequent to the procedure) ","code_information":[{"code":"20555","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Placement of needles or catheters into muscle and/or soft tissue for subsequent interstitial radioelement application (at the time of or subsequent to the procedure) ","code_information":[{"code":"20555","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":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiol ","code_information":[{"code":"361","type":"RC"},{"code":"50433","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug) ","code_information":[{"code":"360","type":"RC"},{"code":"G0269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":54432.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":40036.00,"methodology":"case rate"}]}]},{"description":"Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; o ","code_information":[{"code":"19296","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":54432.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":54432.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":40036.00,"methodology":"case rate"}]}]},{"description":"Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion ","code_information":[{"code":"10035","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"methodology":"case rate"}]}]},{"description":"Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion ","code_information":[{"code":"10035","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"methodology":"case rate"}]}]},{"description":"Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion ","code_information":[{"code":"10035","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3972.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"methodology":"case rate"}]}]},{"description":"Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter re ","code_information":[{"code":"360","type":"RC"},{"code":"47540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological s ","code_information":[{"code":"369","type":"RC"},{"code":"50693","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological s ","code_information":[{"code":"369","type":"RC"},{"code":"50694","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological s ","code_information":[{"code":"481","type":"RC"},{"code":"50695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological s ","code_information":[{"code":"490","type":"RC"},{"code":"50695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological s ","code_information":[{"code":"50695","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Placement of vein patch or cuff at distal anastomosis of bypass graft, synthetic conduit (List separately in addition to code for primary procedure) ","code_information":[{"code":"35685","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Placement of vein patch or cuff at distal anastomosis of bypass graft, synthetic conduit (List separately in addition to code for primary procedure) ","code_information":[{"code":"35685","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"PLASMA CRYO REDUCED ","code_information":[{"code":"122225","type":"CDM"},{"code":"P9044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":371.00,"discounted_cash":371.00,"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":61.22,"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":70.86,"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":66.78,"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":92.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":100.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":100.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":100.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":100.17,"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":81.62,"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":48.23,"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":185.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":100.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":100.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":100.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":87.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":48.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":39.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":64.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":87.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":64.18,"methodology":"percent of total billed charges"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":129.85,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":48.23,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":426.65,"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":81.99,"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":73.83,"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":185.50,"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":59.36,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":34.50,"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":85.33,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":77.91,"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":126.14,"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":85.33,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":100.17,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":70.49,"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":315.35,"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":278.25,"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":34.50,"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":48.23,"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":185.50,"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":296.80,"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":315.35,"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":185.50,"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":50.09,"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":537.95,"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":105.73,"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 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","code_information":[{"code":"361","type":"RC"},{"code":"54300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps ","code_information":[{"code":"369","type":"RC"},{"code":"54304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"481","type":"RC"},{"code":"54380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Plastic 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logic."},{"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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral plication) ","code_information":[{"code":"360","type":"RC"},{"code":"57220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Plastic repair of cleft lip/nasal deformity; primary bilateral, 1 of 2 stages ","code_information":[{"code":"369","type":"RC"},{"code":"40702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Plastic repair of cleft lip/nasal deformity; primary bilateral, 1 of 2 stages ","code_information":[{"code":"40702","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Plastic repair of cleft lip/nasal deformity; primary bilateral, 1 of 2 stages ","code_information":[{"code":"40702","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Plastic repair of cleft lip/nasal deformity; primary bilateral, 1-stage procedure ","code_information":[{"code":"40701","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure ","code_information":[{"code":"361","type":"RC"},{"code":"40720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure 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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":227.47,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":267.03,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":187.91,"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 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"Proctopexy (eg, for prolapse); perineal approach ","code_information":[{"code":"369","type":"RC"},{"code":"45541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Proctopexy (eg, for prolapse); perineal approach ","code_information":[{"code":"45541","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Proctoplasty; for stenosis ","code_information":[{"code":"361","type":"RC"},{"code":"45500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery ","code_information":[{"code":"360","type":"RC"},{"code":"45308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, tibia ","code_information":[{"code":"27745","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, tibia ","code_information":[{"code":"27745","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; clavicle ","code_information":[{"code":"23490","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth 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"},{"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":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":30598.15,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":34914.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":17703.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":13992.08,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":29154.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29154.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":19133.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":34914.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":19133.80,"methodology":"fee schedule"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":28957.30,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":30309.49,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":28866.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31752.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":46447.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":66044.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":30020.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29443.50,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":30886.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30598.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":30598.15,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":32330.12,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":30020.83,"methodology":"fee schedule"},{"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":28288.86,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":28000.19,"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":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30598.15,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1175.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":30309.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":30598.15,"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":36082.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":23549.69,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":30309.49,"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":30020.83,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":30309.49,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":109.00,"standard_charge_algorithm":"Reimbursement will be 109% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":31752.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":30598.15,"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. 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"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":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright 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dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"369","type":"RC"},{"code":"43212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13320.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case 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","code_information":[{"code":"360","type":"RC"},{"code":"43215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter) ","code_information":[{"code":"43195","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance ","code_information":[{"code":"360","type":"RC"},{"code":"43192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"methodology":"case rate"}]}]},{"description":"Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging ","code_information":[{"code":"47536","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case 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","code_information":[{"code":"47536","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging ","code_information":[{"code":"47536","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Excision aural glomus tumor; transcanal ","code_information":[{"code":"360","type":"RC"},{"code":"69550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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","code_information":[{"code":"499","type":"RC"},{"code":"69550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Excision aural polyp ","code_information":[{"code":"369","type":"RC"},{"code":"69540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Excision dermoid cyst, nose; complex, under bone or cartilage ","code_information":[{"code":"30125","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"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":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Excision dermoid cyst, nose; simple, skin, subcutaneous ","code_information":[{"code":"30124","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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","code_information":[{"code":"25240","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Excision external ear; complete amputation ","code_information":[{"code":"481","type":"RC"},{"code":"69120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health 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logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"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":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"54111","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case 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","code_information":[{"code":"11770","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Excision of rectal tumor, transanal approach; including muscularis propria (ie, full thickness) ","code_information":[{"code":"45172","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case 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","code_information":[{"code":"28292","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case 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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) ","code_information":[{"code":"28285","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Cortisol; free ","code_information":[{"code":"82530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.54,"maximum":25.07,"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":17.21,"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 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","plan_name":"TRICR","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.71,"methodology":"fee schedule"}]}]},{"description":"Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; each additional segment (List separately in addition to code for primary proce ","code_information":[{"code":"499","type":"RC"},{"code":"63066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; single segment ","code_information":[{"code":"369","type":"RC"},{"code":"63064","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13594.00,"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":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; single segment ","code_information":[{"code":"63064","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13594.00,"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":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"COVER SCREW BN 3320 ","code_information":[{"code":"868547","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4546.00,"discounted_cash":4546.00,"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":750.09,"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":340.95,"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":868.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 13.8% of billable gross charges.","estimated_amount":627.35,"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":818.28,"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":1136.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1227.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1227.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1227.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1227.42,"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":1000.12,"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":590.98,"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":2273.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1227.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1227.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1227.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":1077.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":595.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":481.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":331.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":313.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":786.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":1077.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":786.46,"methodology":"percent of total billed charges"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":1591.10,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":590.98,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":5227.90,"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":1004.67,"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":904.65,"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":2273.00,"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":727.36,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":422.78,"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":1045.58,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":954.66,"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":1545.64,"methodology":"percent of total billed 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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":3636.80,"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":3864.10,"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":2273.00,"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":613.71,"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":6591.70,"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":1295.61,"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":2045.70,"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":1150.14,"methodology":"percent of total billed charges"}]}]},{"description":"Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract ","code_information":[{"code":"361","type":"RC"},{"code":"61791","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy ","code_information":[{"code":"361","type":"RC"},{"code":"63741","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":11560.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","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":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy ","code_information":[{"code":"481","type":"RC"},{"code":"63741","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":11560.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case 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","code_information":[{"code":"31592","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Cross 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logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Cross intrinsic transfer, each tendon ","code_information":[{"code":"26510","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Cross intrinsic transfer, each tendon ","code_information":[{"code":"26510","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Cross-over vein graft to venous system ","code_information":[{"code":"34520","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":14377.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14377.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10271.00,"methodology":"case rate"}]}]},{"description":"CROSSMATCH IMM SPIN ","code_information":[{"code":"122149","type":"CDM"},{"code":"86920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":743.00,"discounted_cash":743.00,"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":133.74,"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 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","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":854.45,"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":371.50,"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":118.88,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":69.10,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health 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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":211.75,"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":334.35,"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":187.98,"methodology":"percent of total billed charges"}]}]},{"description":"Cryopreservation, freezing and storage of cells, each cell line 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rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Cystostomy, cystotomy with drainage ","code_information":[{"code":"369","type":"RC"},{"code":"51040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case 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logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Cystotomy; for excision of bladder diverticulum, single or multiple (separate procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"51525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Cystourethroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and incision) ","code_information":[{"code":"52343","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":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"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 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","code_information":[{"code":"52341","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":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"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 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logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Anorectal myomectomy ","code_information":[{"code":"45108","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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","code_information":[{"code":"117235","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7654.00,"discounted_cash":7654.00,"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":574.05,"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":1377.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2066.58,"methodology":"percent of total billed 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charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2066.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2066.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2066.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":1814.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":1002.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":811.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":558.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":528.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":1324.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":1814.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":1324.14,"methodology":"percent of total billed charges"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":2678.90,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":995.02,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":8802.10,"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":3827.00,"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":1224.64,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":711.82,"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":1760.42,"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":1760.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2066.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1454.26,"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":6505.90,"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":5740.50,"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":711.82,"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":3827.00,"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":6123.20,"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":6505.90,"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":3827.00,"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":1033.29,"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":11098.30,"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":3444.30,"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 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logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"46600","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":5.80,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.77,"methodology":"fee schedule"}]}]},{"description":"Apolipoprotein, each ","code_information":[{"code":"82172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20.88,"maximum":31.63,"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":21.72,"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":9.80,"standard_charge_algorithm":"Reimbursement will be 9.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":22.36,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":31.63,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":21.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.51,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":26.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":23.62,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":20.88,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":20.88,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":21.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.10,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":23.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":21.20,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":21.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.09,"methodology":"fee schedule"}]}]},{"description":"Appendectomy; ","code_information":[{"code":"44950","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","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":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type) ","code_information":[{"code":"20692","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12056.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system ","code_information":[{"code":"20690","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Application of body cast, shoulder to hips; ","code_information":[{"code":"29035","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of body cast, shoulder to hips; ","code_information":[{"code":"29035","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of body cast, shoulder to hips; including 1 thigh ","code_information":[{"code":"29044","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of body cast, shoulder to hips; including both thighs ","code_information":[{"code":"29046","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of clubfoot cast with molding or manipulation, long or short leg ","code_information":[{"code":"29450","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure) ","code_information":[{"code":"20660","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Application of cylinder cast (thigh to ankle) ","code_information":[{"code":"29365","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure) ","code_information":[{"code":"21100","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":"Application of halo type body cast (see 20661-20663 for insertion) ","code_information":[{"code":"29000","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (eg, pediatric patients, hydrocephalus, osteogenesis imperfecta) ","code_information":[{"code":"20664","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","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":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Application of halo, including removal; pelvic ","code_information":[{"code":"20662","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Application of halo, including removal; pelvic ","code_information":[{"code":"20662","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7427.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5358.00,"methodology":"case rate"}]}]},{"description":"Application of hip spica cast; 1 and one-half spica or both legs ","code_information":[{"code":"29325","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case 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","code_information":[{"code":"29305","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case 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multiple digits, total wound surface area greater than or equal to 100 ","code_information":[{"code":"369","type":"RC"},{"code":"C5278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additio ","code_information":[{"code":"360","type":"RC"},{"code":"C5276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq ","code_information":[{"code":"750","type":"RC"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1622.00,"maximum":3346.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and c ","code_information":[{"code":"499","type":"RC"},{"code":"C5273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition ","code_information":[{"code":"360","type":"RC"},{"code":"C5272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of multi-layer compression system; leg (below knee), including ankle and foot ","code_information":[{"code":"29581","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"29584","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; exchange (ie, remov 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logic."},{"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":3972.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2866.00,"methodology":"case rate"}]}]},{"description":"Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; exchange (ie, remov 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","code_information":[{"code":"29010","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of Risser jacket, localizer, body; only ","code_information":[{"code":"29010","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of short arm splint (forearm to hand); dynamic ","code_information":[{"code":"29126","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of short leg splint (calf to foot) ","code_information":[{"code":"29515","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; fi ","code_information":[{"code":"15277","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq ","code_information":[{"code":"15276","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or les ","code_information":[{"code":"15275","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additiona ","code_information":[{"code":"15274","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children ","code_information":[{"code":"15273","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10185.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10185.00,"methodology":"case 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rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":10185.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7347.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code f ","code_information":[{"code":"15272","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area ","code_information":[{"code":"15271","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"15271","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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":5512.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3977.00,"methodology":"case rate"}]}]},{"description":"Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure) ","code_information":[{"code":"61800","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"29086","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"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 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logic."},{"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":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"Application, cast; shoulder to hand (long arm) ","code_information":[{"code":"29065","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"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":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2076.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1622.00,"methodology":"case rate"}]}]},{"description":"APPLY SPINE PROSTH DEVICE ","code_information":[{"code":"22851","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft ","code_information":[{"code":"490","type":"RC"},{"code":"66180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case 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":11560.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9028.00,"methodology":"case rate"}]}]},{"description":" CT Scan - Other  ","code_information":[{"code":"359","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":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":897.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":632.00,"methodology":"case 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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 Intraocular Lens  ","code_information":[{"code":"276","type":"RC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"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":"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":"Bright Health ","plan_name":"HIX","standard_charge_percentage":35.00,"standard_charge_algorithm":"In addition if aggregated billable gross charges for specific code exceed $1080 reimbursement is 35% 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":"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":"Health Sun Health Plan","plan_name":"MGMCR","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":"Medica HealthCare","plan_name":"MCR","standard_charge_percentage":57.00,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 57% 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":"HIX","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":"Optimum","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":"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":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":"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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_percentage":36.67,"standard_charge_algorithm":"Reimbursement will be 36.67% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":" Medical/Surgical Supplies and Devices Pacemaker  ","code_information":[{"code":"275","type":"RC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":87.60,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 87.6% 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":64.60,"standard_charge_algorithm":"In addition to other contracted rates, reimbursement will be 64.6% 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":"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":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":62.00,"standard_charge_algorithm":"Reimbursement will be 62% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":56.80,"standard_charge_algorithm":"Reimbursement will be 56.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":56.40,"standard_charge_algorithm":"Reimbursement will be 56.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":56.70,"standard_charge_algorithm":"Reimbursement will be 56.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":62.20,"standard_charge_algorithm":"Reimbursement will be 62.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":56.70,"standard_charge_algorithm":"Reimbursement will be 56.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":35.00,"standard_charge_algorithm":"In addition if aggregated billable gross charges for specific code exceed $1080 reimbursement is 35% of aggregated billable gross charges. 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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":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":"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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_percentage":36.67,"standard_charge_algorithm":"Reimbursement will be 36.67% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":" Other Imaging Services Ultrasound  ","code_information":[{"code":"402","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":216.00,"maximum":939.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":256.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":939.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":471.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":382.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":474.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":939.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":474.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":224.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":11.10,"standard_charge_algorithm":"Reimbursement will be 11.1% of billable gross charges.","estimated_amount":1022.72,"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":946.62,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":216.00,"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":585.14,"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":" Pharmacy Generic Drugs  ","code_information":[{"code":"251","type":"RC"}],"standard_charges":[{"setting":"inpatient","payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":35.00,"standard_charge_algorithm":"In addition if aggregated billable gross charges for specific code exceed $1000 reimbursement is 35% 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":"Bright Health ","plan_name":"HIX","standard_charge_percentage":26.00,"standard_charge_algorithm":"In addition if aggregated billable gross charges for specific code exceed $21600 reimbursement is 26% of aggregated billable gross charges. If aggregated billable gross charges are less than $21600 then reimbursement for the specified code will be zero.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":" Room & Board - Deluxe Private Rehabilitation  ","code_information":[{"code":"148","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":1439.00,"maximum":62413.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":2680.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":2766.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":2043.00,"methodology":"per diem"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1828.00,"methodology":"per diem"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":1439.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":4626.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5657.00,"methodology":"per diem"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6650.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":53498.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":62413.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1456.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_dollar":6300.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":2149.00,"methodology":"per diem"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2090.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $429020.00, reimbursement will be $7851 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1713.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $429020.00, reimbursement will be $6331 per diem instead of the contracted rate."}]}]},{"description":" Room & Board - Three and Four Beds Rehabilitation  ","code_information":[{"code":"138","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":1439.00,"maximum":62413.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":2680.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":2766.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":2043.00,"methodology":"per diem"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1828.00,"methodology":"per diem"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":1439.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":4626.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5657.00,"methodology":"per diem"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6650.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":53498.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":62413.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1456.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_dollar":6300.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":2149.00,"methodology":"per diem"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2090.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $429020.00, reimbursement will be $7851 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1713.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $429020.00, reimbursement will be $6331 per diem instead of the contracted rate."}]}]},{"description":" Subacute Care - Level IV  ","code_information":[{"code":"194","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":1185.00,"maximum":6650.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":2401.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":2766.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":1830.00,"methodology":"per diem"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":1638.00,"methodology":"per diem"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":1290.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":4626.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":5657.00,"methodology":"per diem"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6650.00,"methodology":"fee 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","plan_name":"MCR","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":32.00,"standard_charge_algorithm":"Reimbursement will be 32% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":7500.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":44.00,"standard_charge_algorithm":"Reimbursement will be 44% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":41.00,"standard_charge_algorithm":"Reimbursement will be 41% of billable gross 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"},{"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":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":10462.75,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":10399.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":5273.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4167.74,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":9969.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9969.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":5699.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":10399.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":5699.27,"methodology":"fee schedule"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":9074.14,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":10364.05,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":9870.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10857.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":14554.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":20696.01,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":10265.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10067.93,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":10561.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10462.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":10462.75,"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":12338.15,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7379.60,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":10364.05,"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":10265.34,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":10364.05,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":109.00,"standard_charge_algorithm":"Reimbursement will be 109% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":10857.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10462.75,"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. 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total billed charges"},{"payer_name":"BLIS","plan_name":"COMM","standard_charge_percentage":35.00,"standard_charge_algorithm":"Reimbursement will be 35% of billable gross charges.","estimated_amount":467.60,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":173.68,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":1536.40,"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":295.26,"methodology":"percent of total billed 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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":124.25,"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":173.68,"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":668.00,"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":1068.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime 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","plan_name":"MCR","standard_charge_dollar":1311.90,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":1305.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1305.37,"methodology":"fee schedule"}]}]},{"description":"AE1 AE3 PEROX EA ADDL AB ","code_information":[{"code":"791471","type":"CDM"},{"code":"88341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":425.00,"discounted_cash":425.00,"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":76.50,"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 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","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":488.75,"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":212.50,"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":68.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":39.53,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health 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","code_information":[{"code":"912520","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5393.00,"discounted_cash":5393.00,"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":889.85,"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":404.48,"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":1030.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 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