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","code_information":[{"code":"81165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":240.00,"maximum":668.13,"payers_information":[{"payer_name":"Aetna","plan_name":"LocalOpen","standard_charge_dollar":584.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"LocalPreferred","standard_charge_dollar":434.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NationalOpen","standard_charge_dollar":668.13,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":249.60,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":249.60,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":297.02,"methodology":"fee schedule"},{"payer_name":"Correct Care 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","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1200.00,"maximum":14868.12,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":6633.12,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":9912.08,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":6633.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":12535.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":12535.18,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"COMM","standard_charge_dollar":10395.72,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":10209.44,"methodology":"fee schedule"},{"payer_name":"Correct Care 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schedule"},{"payer_name":"Humana","plan_name":"MGMCRSNP","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":59.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":59.40,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":33.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":33.64,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":33.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC ","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1200.00,"maximum":8609.07,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":6914.96,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":5739.38,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":6914.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":7444.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":7444.29,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"COMM","standard_charge_dollar":5578.86,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":5911.56,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":8609.07,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":8609.07,"methodology":"fee schedule"},{"payer_name":"First Health","plan_name":"PPO","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"CignaLocalPlusNetwork","standard_charge_percentage":18.70,"standard_charge_algorithm":"Reimbursement will be 18.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Humana","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":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":5739.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":5739.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":5739.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPOS","standard_charge_dollar":5739.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPPO","standard_charge_dollar":5739.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRSNP","standard_charge_dollar":5739.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":7805.36,"methodology":"fee schedule"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":96.00,"standard_charge_algorithm":"Reimbursement will be 96% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":4986.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $493345.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":"IndivdualExchange","standard_charge_dollar":4379.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $448495.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5636.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":6649.00,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","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":"USA Managed Care","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"WPPA","plan_name":"PrimeNetwork","standard_charge_dollar":5083.76,"methodology":"fee schedule"},{"payer_name":"WPPA","plan_name":"ProviderCareNetwork","standard_charge_dollar":6517.30,"methodology":"fee schedule"},{"payer_name":"WPPA","plan_name":"UnifiedHealthPlan","standard_charge_dollar":4562.11,"methodology":"fee schedule"}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC ","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1200.00,"maximum":9160.15,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":3538.08,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":6106.77,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":3538.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":6449.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":6449.28,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"COMM","standard_charge_dollar":6002.97,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":6289.97,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":9160.15,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":9160.15,"methodology":"fee schedule"},{"payer_name":"First Health","plan_name":"PPO","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"CignaLocalPlusNetwork","standard_charge_percentage":18.70,"standard_charge_algorithm":"Reimbursement will be 18.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Humana","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":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":6106.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":6106.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":6106.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPOS","standard_charge_dollar":6106.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPPO","standard_charge_dollar":6106.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRSNP","standard_charge_dollar":6106.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":3993.44,"methodology":"fee schedule"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":96.00,"standard_charge_algorithm":"Reimbursement will be 96% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":4986.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $493345.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":"IndivdualExchange","standard_charge_dollar":4379.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $448495.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5996.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":3402.00,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","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":"USA Managed Care","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"WPPA","plan_name":"PrimeNetwork","standard_charge_dollar":5470.22,"methodology":"fee schedule"},{"payer_name":"WPPA","plan_name":"ProviderCareNetwork","standard_charge_dollar":7012.75,"methodology":"fee schedule"},{"payer_name":"WPPA","plan_name":"UnifiedHealthPlan","standard_charge_dollar":4908.92,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; antithrombin III, activity ","code_information":[{"code":"23878","type":"CDM"},{"code":"85300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.00,"maximum":29.65,"gross_charge":853.00,"discounted_cash":853.00,"payers_information":[{"payer_name":"Aetna","plan_name":"LocalOpen","standard_charge_dollar":24.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"LocalPreferred","standard_charge_dollar":18.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NationalOpen","standard_charge_dollar":27.99,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":11.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPOS","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPPO","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRSNP","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":11.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Clotting; factor V (AcG or proaccelerin), labile factor ","code_information":[{"code":"16355","type":"CDM"},{"code":"85220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.00,"maximum":47.90,"gross_charge":1401.00,"discounted_cash":1401.00,"payers_information":[{"payer_name":"Aetna","plan_name":"LocalOpen","standard_charge_dollar":36.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"LocalPreferred","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NationalOpen","standard_charge_dollar":41.69,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":47.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":47.90,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":26.47,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":26.47,"methodology":"fee 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","code_information":[{"code":"E0168","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":132.47,"maximum":198.70,"payers_information":[{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":132.47,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":139.09,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":198.70,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":198.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":132.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":132.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":132.47,"methodology":"fee 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schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPOS","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPPO","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRSNP","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.06,"methodology":"fee 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charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Humana","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":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":15275.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":15275.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":15275.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPOS","standard_charge_dollar":15275.81,"methodology":"fee 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If billable gross charges exceed threshold of $493345.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":"IndivdualExchange","standard_charge_dollar":4379.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $448495.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15000.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":9703.00,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","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":"USA Managed Care","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per 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","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1200.00,"maximum":10961.25,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":6150.56,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":7307.50,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":6150.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":7613.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":7613.03,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"COMM","standard_charge_dollar":7389.06,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":7526.73,"methodology":"fee schedule"},{"payer_name":"Correct Care 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charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":7307.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":7307.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":7307.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPOS","standard_charge_dollar":7307.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPPO","standard_charge_dollar":7307.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRSNP","standard_charge_dollar":7307.50,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":96.00,"standard_charge_algorithm":"Reimbursement will be 96% of billable gross 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If billable gross charges exceed threshold of $448495.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7175.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":5914.00,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","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":"USA Managed Care","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per 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If billable gross charges exceed threshold of $448495.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19251.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":19755.00,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","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":"USA Managed Care","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per 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","code_information":[{"code":"K0017","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":55.77,"maximum":83.66,"payers_information":[{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":58.56,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":83.66,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":83.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":55.77,"methodology":"fee 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","code_information":[{"code":"16067","type":"CDM"},{"code":"82638","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.00,"maximum":30.00,"gross_charge":1342.00,"discounted_cash":1342.00,"payers_information":[{"payer_name":"Aetna","plan_name":"LocalOpen","standard_charge_dollar":25.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"LocalPreferred","standard_charge_dollar":18.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NationalOpen","standard_charge_dollar":28.93,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":30.00,"methodology":"fee 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","code_information":[{"code":"18685","type":"CDM"},{"code":"86704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.00,"maximum":30.55,"gross_charge":1683.00,"discounted_cash":1683.00,"payers_information":[{"payer_name":"Aetna","plan_name":"LocalOpen","standard_charge_dollar":24.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"LocalPreferred","standard_charge_dollar":18.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NationalOpen","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":30.55,"methodology":"fee 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schedule"},{"payer_name":"Humana","plan_name":"MGMCRSNP","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":12.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC ","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1800.00,"maximum":40890.01,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":12825.28,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":27260.01,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":12825.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":35845.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":35845.42,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"COMM","standard_charge_dollar":30421.70,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":28077.81,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":40890.01,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":40890.01,"methodology":"fee schedule"},{"payer_name":"First Health","plan_name":"PPO","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"CignaLocalPlusNetwork","standard_charge_percentage":18.70,"standard_charge_algorithm":"Reimbursement will be 18.7% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Humana","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":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":27260.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":27260.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":27260.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPOS","standard_charge_dollar":27260.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPPO","standard_charge_dollar":27260.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRSNP","standard_charge_dollar":27260.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":14476.22,"methodology":"fee schedule"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":96.00,"standard_charge_algorithm":"Reimbursement will be 96% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6977.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $493345.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":"IndivdualExchange","standard_charge_dollar":6067.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $448495.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":26769.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":12332.00,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","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":"USA Managed Care","plan_name":"COMM","standard_charge_dollar":1800.00,"methodology":"per diem"},{"payer_name":"WPPA","plan_name":"PrimeNetwork","standard_charge_dollar":27721.87,"methodology":"fee schedule"},{"payer_name":"WPPA","plan_name":"ProviderCareNetwork","standard_charge_dollar":35539.04,"methodology":"fee schedule"},{"payer_name":"WPPA","plan_name":"UnifiedHealthPlan","standard_charge_dollar":24877.33,"methodology":"fee schedule"}]}]},{"description":"Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer, hereditary pancreatic cancer, hereditary prostate cancer), genomic s ","code_information":[{"code":"81432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":679.05,"maximum":1603.85,"payers_information":[{"payer_name":"Aetna","plan_name":"LocalOpen","standard_charge_dollar":1403.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"LocalPreferred","standard_charge_dollar":1042.55,"methodology":"fee 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If billable gross charges exceed threshold of $493345.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":"IndivdualExchange","standard_charge_dollar":6067.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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","code_information":[{"code":"L3764","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":795.38,"maximum":1193.07,"payers_information":[{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":795.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":915.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":915.27,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":835.15,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":1193.07,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":1193.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":795.38,"methodology":"fee 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If billable gross charges exceed threshold of $448495.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14900.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":9317.00,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","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":"USA Managed Care","plan_name":"COMM","standard_charge_dollar":1800.00,"methodology":"per 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","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1800.00,"maximum":18264.22,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":5025.28,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":12176.15,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":5025.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":13542.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":13542.59,"methodology":"fee schedule"},{"payer_name":"Centene","plan_name":"COMM","standard_charge_dollar":13009.30,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":12541.43,"methodology":"fee schedule"},{"payer_name":"Correct Care 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If billable gross charges exceed threshold of $493345.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","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":"IndivdualExchange","standard_charge_dollar":6067.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $448495.00, reimbursement will be $4638 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11956.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":4832.00,"methodology":"fee schedule"},{"payer_name":"USA Managed Care","plan_name":"COMM","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":"USA Managed Care","plan_name":"COMM","standard_charge_dollar":1800.00,"methodology":"per 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procedure logic."}]}]},{"description":"Tlso, corset front ","code_information":[{"code":"L0970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":125.74,"maximum":386.47,"payers_information":[{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":125.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":386.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":386.47,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":132.03,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":188.61,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":188.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":125.74,"methodology":"fee 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","code_information":[{"code":"L0492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":552.83,"maximum":829.25,"payers_information":[{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":552.83,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":580.47,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":829.25,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":829.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":552.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":552.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":552.83,"methodology":"fee 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schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":16.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; known familial variant ","code_information":[{"code":"81353","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261.00,"maximum":727.47,"payers_information":[{"payer_name":"Aetna","plan_name":"LocalOpen","standard_charge_dollar":636.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"LocalPreferred","standard_charge_dollar":472.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NationalOpen","standard_charge_dollar":727.47,"methodology":"fee schedule"},{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":271.44,"methodology":"fee schedule"},{"payer_name":"Aetna Coventry","plan_name":"MCR","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":271.44,"methodology":"fee schedule"},{"payer_name":"Centene Celtic","plan_name":"MGMCR","standard_charge_dollar":323.40,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"COMM","standard_charge_dollar":462.00,"methodology":"fee schedule"},{"payer_name":"Correct Care Solutions","plan_name":"PRISON","standard_charge_dollar":462.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"DualEligibles","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRHMO","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPFFS","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MGMCRPOS","standard_charge_dollar":308.00,"methodology":"fee 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","code_information":[{"code":"72133","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101.00,"maximum":626.00,"payers_information":[{"payer_name":"Aetna","plan_name":"LocalOpen","standard_charge_dollar":548.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"LocalPreferred","standard_charge_dollar":407.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"NationalOpen","standard_charge_dollar":626.00,"methodology":"per diem"},{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":105.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":105.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":477.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":477.79,"methodology":"fee 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logic."}]}]},{"description":"Revision, lower extremity arterial bypass, without thrombectomy, open; with vein patch angioplasty ","code_information":[{"code":"35879","type":"CPT"}],"standard_charges":[{"modifiers":"50","modifiers_description":"Bilateral Procedure","setting":"outpatient","minimum":1780.00,"maximum":1851.20,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":1851.20,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":1851.20,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":1833.40,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":1780.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"RING ANLPLS TRICUSP 24MM 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charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Humana","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":249.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross charges.","estimated_amount":121.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":448.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross 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lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s ","code_information":[{"code":"29880","type":"CPT"}],"standard_charges":[{"modifiers":"50","modifiers_description":"Bilateral Procedure","setting":"outpatient","minimum":1048.00,"maximum":1089.92,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":1089.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":1089.92,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":1079.44,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":1048.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Arthrotomy, ankle, including exploration, drainage, or removal of foreign body ","code_information":[{"code":"27610","type":"CPT"}],"standard_charges":[{"modifiers":"50","modifiers_description":"Bilateral Procedure","setting":"outpatient","minimum":1048.00,"maximum":1089.92,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":1089.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":1089.92,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":1079.44,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":1048.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Arthrotomy, with biopsy; sacroiliac joint ","code_information":[{"code":"27050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":520.00,"maximum":2672.01,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":540.80,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":540.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2672.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2672.01,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":535.60,"methodology":"fee schedule"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":520.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"ASP ABS/CYST SKIN ","code_information":[{"code":"119100","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":12892.00,"discounted_cash":12892.00,"payers_information":[{"payer_name":"Aetna","plan_name":"LocalOpen","standard_charge_percentage":25.76,"standard_charge_algorithm":"Reimbursement will be 25.76% of billable gross charges.","estimated_amount":3320.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"LocalPreferred","standard_charge_percentage":19.14,"standard_charge_algorithm":"Reimbursement will be 19.14% of billable gross charges.","estimated_amount":2467.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NationalOpen","standard_charge_percentage":26.37,"standard_charge_algorithm":"Reimbursement will be 26.37% of billable gross charges.","estimated_amount":3399.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":3867.60,"methodology":"percent of total billed charges"},{"payer_name":"First Health","plan_name":"PPO","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":6252.62,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"CignaLocalPlusNetwork","standard_charge_percentage":18.70,"standard_charge_algorithm":"Reimbursement will be 18.7% of billable gross charges.","estimated_amount":2410.80,"methodology":"percent of 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billed charges"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":61.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":42.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":16.10,"standard_charge_algorithm":"Reimbursement will be 16.1% of billable gross charges.","estimated_amount":15.18,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":80.14,"methodology":"percent of total billed charges"},{"payer_name":"WPPA","plan_name":"PrimeNetwork","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":18.01,"methodology":"percent of total billed charges"},{"payer_name":"WPPA","plan_name":"ProviderCareNetwork","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":18.01,"methodology":"percent of total billed charges"},{"payer_name":"WPPA","plan_name":"UnifiedHealthPlan","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":18.01,"methodology":"percent of total billed charges"}]}]},{"description":"AUG FEM KN SZ6/7 5MM ","code_information":[{"code":"585170","type":"CDM"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":6204.00,"discounted_cash":6204.00,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1861.20,"methodology":"percent of total billed charges"},{"payer_name":"First Health","plan_name":"PPO","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":3008.94,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"CignaLocalPlusNetwork","standard_charge_percentage":18.70,"standard_charge_algorithm":"Reimbursement will be 18.7% of billable gross charges.","estimated_amount":1160.15,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of 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total billed charges"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5569.20,"methodology":"percent of total billed charges"}]}]},{"description":"Injection procedure for temporomandibular joint arthrography ","code_information":[{"code":"21116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.00,"maximum":13.52,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_percentage":34.65,"standard_charge_algorithm":"Reimbursement will be 34.65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_percentage":34.65,"standard_charge_algorithm":"Reimbursement will be 34.65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":13.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; plantar common digital nerve(s) (eg, Morton's neuroma) ","code_information":[{"code":"64455","type":"CPT"}],"standard_charges":[{"modifiers":"50","modifiers_description":"Bilateral Procedure","setting":"outpatient","minimum":111.00,"maximum":115.44,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":115.44,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":115.44,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":111.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia) ","code_information":[{"code":"20550","type":"CPT"}],"standard_charges":[{"modifiers":"50","modifiers_description":"Bilateral Procedure","setting":"outpatient","minimum":192.00,"maximum":199.68,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":199.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":199.68,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":197.76,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":192.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, aripiprazole lauroxil, (aristada initio), 1 mg ","code_information":[{"code":"J1943","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.00,"maximum":3.88,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":3.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, chlorothiazide sodium, per 500 mg ","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"32300","type":"CDM"},{"code":"J1205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":63.00,"maximum":98.89,"gross_charge":537.89,"discounted_cash":537.89,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":65.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":65.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":98.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":98.89,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":64.89,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":63.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, dipyridamole, per 10 mg ","code_information":[{"code":"J1245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.00,"maximum":4.76,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":3.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":3.09,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":3.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. ","code_information":[{"code":"J7211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.00,"maximum":1.73,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":1.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, hydrocortisone sodium phosphate, up to 50 mg ","code_information":[{"code":"J1710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5.00,"maximum":9.22,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":5.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, linezolid (hospira), not therapeutically equivalent to j2020, 200 mg ","code_information":[{"code":"J2021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":14.00,"maximum":22.92,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":22.92,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":14.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, mitomycin, 5 mg ","code_information":[{"code":"J9280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":54.00,"maximum":60.90,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":56.16,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":56.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":60.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":60.90,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":55.62,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":54.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, penicillin g benzathine, 100,000 units ","code_information":[{"code":"J0561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":23.00,"maximum":24.55,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":23.92,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":23.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":24.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":24.55,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":23.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, secukinumab, intravenous, 1 mg ","code_information":[{"code":"J3247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17.00,"maximum":17.68,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":17.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, trastuzumab, 10 mg and hyaluronidase-oysk ","code_information":[{"code":"J9356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":64.00,"maximum":84.24,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":66.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":65.92,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":64.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg ","drug_information":{"unit":"1000","type":"GM"},"code_information":[{"code":"7281","type":"CDM"},{"code":"J3420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.00,"maximum":2.63,"gross_charge":476.92,"discounted_cash":476.92,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BlueChoice","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"Cap","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":1.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"INS TIB 3X15 CRV XLNK ","code_information":[{"code":"679174","type":"CDM"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2073.00,"discounted_cash":2073.00,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":621.90,"methodology":"percent of total billed charges"},{"payer_name":"First Health","plan_name":"PPO","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":1005.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"CignaLocalPlusNetwork","standard_charge_percentage":18.70,"standard_charge_algorithm":"Reimbursement will be 18.7% of billable gross charges.","estimated_amount":387.65,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Humana","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1036.50,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross charges.","estimated_amount":505.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1865.70,"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":1762.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1451.10,"methodology":"percent of total billed charges"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1347.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":932.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":16.10,"standard_charge_algorithm":"Reimbursement will be 16.1% of billable gross charges.","estimated_amount":333.75,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1762.05,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ACTB TRDNT AL ","code_information":[{"code":"909771","type":"CDM"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":5774.80,"discounted_cash":5774.80,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1732.44,"methodology":"percent of total billed charges"},{"payer_name":"First Health","plan_name":"PPO","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":2800.78,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"CignaLocalPlusNetwork","standard_charge_percentage":18.70,"standard_charge_algorithm":"Reimbursement will be 18.7% of billable gross charges.","estimated_amount":1079.89,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Humana","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2887.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross charges.","estimated_amount":1409.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5197.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4908.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4042.36,"methodology":"percent of total billed charges"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3753.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2598.66,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":16.10,"standard_charge_algorithm":"Reimbursement will be 16.1% of billable gross charges.","estimated_amount":929.74,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4908.58,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT ARTC KN 6-9 10MM ","code_information":[{"code":"844344","type":"CDM"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":3102.00,"discounted_cash":3102.00,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":930.60,"methodology":"percent of total billed charges"},{"payer_name":"First Health","plan_name":"PPO","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":1504.47,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"CignaLocalPlusNetwork","standard_charge_percentage":18.70,"standard_charge_algorithm":"Reimbursement will be 18.7% of billable gross charges.","estimated_amount":580.07,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Humana","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1551.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross charges.","estimated_amount":756.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2791.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2636.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2171.40,"methodology":"percent of total billed charges"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2016.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1395.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":16.10,"standard_charge_algorithm":"Reimbursement will be 16.1% of billable gross charges.","estimated_amount":499.42,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2636.70,"methodology":"percent of total billed charges"}]}]},{"description":"INSERT HUM RVRS SHLDR ","code_information":[{"code":"974523","type":"CDM"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2896.00,"discounted_cash":2896.00,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross 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charges"},{"payer_name":"Aetna","plan_name":"LocalPreferred","standard_charge_percentage":19.14,"standard_charge_algorithm":"Reimbursement will be 19.14% of billable gross charges.","estimated_amount":608.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NationalOpen","standard_charge_percentage":26.37,"standard_charge_algorithm":"Reimbursement will be 26.37% of billable gross charges.","estimated_amount":838.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":953.70,"methodology":"percent of total billed charges"},{"payer_name":"Centene","plan_name":"COMM","standard_charge_percentage":20.00,"standard_charge_algorithm":"Reimbursement will be 20% of billable gross charges.","estimated_amount":635.80,"methodology":"percent of total billed charges"},{"payer_name":"First Health","plan_name":"PPO","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":1541.82,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"CignaLocalPlusNetwork","standard_charge_percentage":18.70,"standard_charge_algorithm":"Reimbursement will be 18.7% of billable gross charges.","estimated_amount":594.47,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Humana","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1589.50,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross 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65% of billable gross charges.","estimated_amount":70.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":49.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":16.10,"standard_charge_algorithm":"Reimbursement will be 16.1% of billable gross charges.","estimated_amount":17.57,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":92.75,"methodology":"percent of total billed charges"},{"payer_name":"WPPA","plan_name":"PrimeNetwork","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross 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billed charges"},{"payer_name":"Triwest Healthcare Alliance","plan_name":"Tricare","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":224.09,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":155.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":16.10,"standard_charge_algorithm":"Reimbursement will be 16.1% of billable gross charges.","estimated_amount":55.50,"methodology":"percent of total billed charges"},{"payer_name":"USA Managed Care","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":293.04,"methodology":"percent of total billed charges"}]}]},{"description":"TISSUE SYNTH CERM CA 5ML ","code_information":[{"code":"43434","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1082.00,"discounted_cash":1082.00,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":324.60,"methodology":"percent of total billed charges"},{"payer_name":"First Health","plan_name":"PPO","standard_charge_percentage":48.50,"standard_charge_algorithm":"Reimbursement will be 48.5% of billable gross charges.","estimated_amount":524.77,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"CignaLocalPlusNetwork","standard_charge_percentage":18.70,"standard_charge_algorithm":"Reimbursement will be 18.7% of billable gross charges.","estimated_amount":202.33,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Humana","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":541.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Partners of Kansas","plan_name":"Non-LocalPlusandNon-ConnectCare","standard_charge_percentage":24.40,"standard_charge_algorithm":"Reimbursement will be 24.4% of billable gross charges.","estimated_amount":264.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":973.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross 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primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments ","code_information":[{"code":"27409","type":"CPT"}],"standard_charges":[{"modifiers":"50","modifiers_description":"Bilateral Procedure","setting":"outpatient","minimum":2317.00,"maximum":2409.68,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":2409.68,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":2409.68,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":2386.51,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":2317.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site ","code_information":[{"code":"36578","type":"CPT"}],"standard_charges":[{"modifiers":"50","modifiers_description":"Bilateral Procedure","setting":"outpatient","minimum":163.00,"maximum":169.52,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":169.52,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":169.52,"methodology":"fee schedule"},{"payer_name":"Sunflower State Health Plan","plan_name":"MCD","standard_charge_dollar":167.89,"methodology":"fee schedule"},{"payer_name":"United Healthcare","plan_name":"MGMCD","standard_charge_dollar":163.00,"methodology":"fee schedule","additional_payer_notes":"The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Resection of apical lung tumor (eg, Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; with chest wall reconstruction ","code_information":[{"code":"32504","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1739.00,"maximum":1808.56,"payers_information":[{"payer_name":"Aetna Better Health","plan_name":"MCD","standard_charge_dollar":1808.56,"methodology":"fee schedule"},{"payer_name":"Amerigroup","plan_name":"MCD","standard_charge_dollar":1808.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_percentage":34.65,"standard_charge_algorithm":"Reimbursement will be 34.65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_percentage":34.65,"standard_charge_algorithm":"Reimbursement will be 34.65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunflower State Health 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