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"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":38265.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10507.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10823.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. 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"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10507.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":25591.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10045.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":19125.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":10507.99,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":10297.83,"methodology":"fee schedule"}]}]},{"description":"MALIGNANT BREAST DISORDERS WITH CC ","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":860.00,"maximum":31617.28,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":7647.78,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7724.26,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":7647.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":8030.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8106.65,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10509.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13279.09,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10509.03,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":7724.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":7724.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13949.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":31617.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13949.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10509.03,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":7647.78,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7965.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":8412.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":17217.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":27501.16,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":7647.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7877.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5594.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":5650.90,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":6098.50,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":5248.06,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":5427.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":14598.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14737.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":55248.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":26654.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":50733.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6988.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8830.52,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6988.45,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":14042.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":14042.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9276.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":21025.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9276.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6988.45,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":13903.38,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":14481.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":15293.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":31300.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":49996.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13903.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14320.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13903.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":14042.41,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":15154.68,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":14515.13,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":13486.28,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":13903.38,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":13625.31,"methodology":"fee schedule"}]}]},{"description":"Sirolimus ","code_information":[{"code":"687976","type":"CDM"},{"code":"80195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.45,"maximum":17.16,"gross_charge":20.70,"discounted_cash":20.70,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":7.80,"standard_charge_algorithm":"Reimbursement will be 7.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":15.10,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":14.97,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":13.73,"methodology":"fee schedule"}]}]},{"description":"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC ","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":860.00,"maximum":66479.54,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":14152.19,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14293.71,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":14152.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. 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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6778.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8565.38,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6778.61,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":16155.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":16155.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8998.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20394.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8998.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6778.61,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":15995.91,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":16660.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":17595.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":36010.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":57520.73,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":15995.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16475.79,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":15995.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15292.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10295.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13008.82,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10295.14,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":18075.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":18075.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13665.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":30973.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13665.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10295.14,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":17896.33,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":18639.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":19685.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":40289.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":64354.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":17896.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18433.22,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17896.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":18075.29,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":19507.00,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":16786.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17359.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":18970.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","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":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":22370.41,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":18075.29,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":18075.29,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":18075.29,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21452.38,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"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":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":18791.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":21207.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":17896.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17108.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":17896.33,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":17538.40,"methodology":"fee schedule"}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC ","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":860.00,"maximum":55248.00,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":13365.36,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13499.01,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":13365.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":14033.63,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14167.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":55248.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":26654.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":50733.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10578.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13367.47,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10578.97,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":13499.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":13499.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14042.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":31827.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14042.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10578.97,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":13365.36,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13920.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":14701.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":30088.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":48061.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13365.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13766.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13365.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":13499.01,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":14568.24,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":13953.44,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":12964.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":4493.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4295.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3660.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":3522.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":3522.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":3798.67,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":3695.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3798.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3695.07,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":3764.14,"methodology":"fee 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","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":860.00,"maximum":33523.40,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":8826.60,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8914.86,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":8826.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":4766.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4556.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":27496.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":34744.41,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":27496.61,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":11066.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":11066.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":36499.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":82725.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":36499.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":27496.61,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":10956.69,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11411.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":12052.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":24666.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":39399.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10956.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11285.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10956.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":11066.26,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":11942.79,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":10277.38,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10627.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":11614.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","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":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":13695.86,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":11066.26,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":11066.26,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":11066.26,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13133.81,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"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":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":11504.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":12983.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10956.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10474.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":10956.69,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":10737.56,"methodology":"fee schedule"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC ","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":860.00,"maximum":42846.14,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":11915.06,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12034.21,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":11915.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":12510.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12629.96,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11915.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. 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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":33743.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":42637.32,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":33743.03,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":15599.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":15599.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":44790.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":101518.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":44790.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":33743.03,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":15445.13,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":16086.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":16989.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":34770.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":55540.16,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":15445.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15908.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15445.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":15599.58,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":16835.19,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":14487.53,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":14981.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":16371.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","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":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":19306.41,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":15599.58,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":15599.58,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":15599.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18514.11,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"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":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":16217.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":18302.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":15445.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14765.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":15445.13,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":15136.23,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only ","code_information":[{"code":"E2376","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be 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Care","plan_name":"MCR","standard_charge_dollar":146.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":154.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":149.80,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":146.86,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each ","code_information":[{"code":"E2313","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":40.79,"maximum":46.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":42.05,"methodology":"fee schedule"},{"payer_name":"Align Senior 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schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":342.11,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":332.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":342.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":332.78,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":339.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":342.11,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":326.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":301.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive 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schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2321.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2258.29,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":2300.50,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":2321.61,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":2216.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2047.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":2110.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":2216.08,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":2152.76,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":2110.55,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds ","code_information":[{"code":"K0856","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":970.57,"maximum":1100.65,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1000.59,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":1070.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":1030.61,"methodology":"fee schedule"},{"payer_name":"Alignment 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":6258.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5983.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":6258.44,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":6133.27,"methodology":"fee schedule"}]}]},{"description":"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC ","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":860.00,"maximum":29576.96,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":4360.14,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4403.74,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":4360.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19100.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":24075.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19100.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":4403.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":4403.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":24628.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":29576.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":24628.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19100.00,"methodology":"case rate"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":4360.14,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4541.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":4796.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":9815.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":15678.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":4360.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4490.94,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4360.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":4403.74,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":4752.55,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":4089.81,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":4229.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":5616.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","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":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":6623.32,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":5351.64,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":5351.64,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":5351.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6351.51,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"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":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":5563.59,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":6278.90,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":5298.65,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":5192.68,"methodology":"fee schedule"}]}]},{"description":"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC ","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":860.00,"maximum":31727.40,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":8823.06,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8911.29,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":8823.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":9264.21,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9352.44,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":8823.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8434.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":4738.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4783.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7163.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9052.12,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7163.82,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":4557.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":4557.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9509.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":21552.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9509.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7163.82,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":4512.54,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4700.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":4963.79,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":10158.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":16226.93,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":4512.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4647.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4512.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":4557.66,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":4918.67,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":4232.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":4377.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":4783.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","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":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":5640.67,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":4557.66,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":4557.66,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":4557.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5409.19,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"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":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":4738.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":5347.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":4512.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4313.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":4512.54,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":4422.29,"methodology":"fee schedule"}]}]},{"description":"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing ","code_information":[{"code":"A6223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.21,"maximum":3.64,"payers_information":[{"payer_name":"Aetna 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schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":3.31,"methodology":"fee schedule"}]}]},{"description":"Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard ","code_information":[{"code":"A6266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2.53,"maximum":2.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":2.87,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":2.84,"methodology":"fee 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","code_information":[{"code":"A6402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.15,"maximum":0.17,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":0.17,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":0.17,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"NDMS 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adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5333.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":5131.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":5131.82,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6289.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":5534.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":5383.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5534.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5383.38,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":5484.01,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":5534.32,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":5282.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4560.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":5031.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6238.69,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":5282.76,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":5131.82,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":5031.20,"methodology":"fee 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charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":7.80,"standard_charge_algorithm":"Reimbursement will be 7.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":2899.65,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":2791.25,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":2980.95,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2872.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":2764.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":2764.15,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":3387.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":2980.95,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":2899.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2980.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2899.65,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":2953.85,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":2980.95,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":2845.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2456.21,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":2709.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3360.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":2845.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":2764.15,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":2709.95,"methodology":"fee schedule"}]}]},{"description":"Glucagon tolerance panel; for insulinoma This panel must include the following: Glucose (82947 x 3) Insulin (83525 x 3) ","code_information":[{"code":"80422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41.76,"maximum":57.59,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":7.80,"standard_charge_algorithm":"Reimbursement will be 7.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":47.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":50.68,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":48.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":57.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":49.29,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":46.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":57.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":46.99,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":46.07,"methodology":"fee schedule"}]}]},{"description":"Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use ","code_information":[{"code":"82962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2.97,"maximum":4.10,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":7.80,"standard_charge_algorithm":"Reimbursement will be 7.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":3.61,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3.61,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":3.28,"methodology":"fee schedule"}]}]},{"description":"Glucose, body fluid, other than blood ","code_information":[{"code":"82945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.56,"maximum":4.91,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":7.80,"standard_charge_algorithm":"Reimbursement will be 7.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6450.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8150.37,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6450.17,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":8410.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":8410.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8562.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19405.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8562.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6450.17,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":8327.57,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8673.55,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":9160.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":18747.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":29945.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8327.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8577.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":8410.84,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":9077.05,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":7811.26,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8077.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":8827.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","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":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":10409.46,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":8410.84,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":8410.84,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":8410.84,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9982.28,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"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":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":8743.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":9868.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":8327.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7961.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":8327.57,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":8161.02,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for infectious agent antibody, quantitative, not otherwise specified ","code_information":[{"code":"86317","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.59,"maximum":18.74,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable 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Health","plan_name":"MCR","standard_charge_dollar":16.49,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":16.49,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":16.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.49,"methodology":"fee 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","code_information":[{"code":"L5645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":907.16,"maximum":1028.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":935.22,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":1000.69,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":963.28,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":1028.74,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":991.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":953.92,"methodology":"fee schedule"},{"payer_name":"BCBS 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schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":935.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":981.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":953.92,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":935.22,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, long tongue stirrup ","code_information":[{"code":"L2265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":125.68,"maximum":142.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":129.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":138.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":133.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":142.53,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":137.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":132.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":132.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":142.53,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":138.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":142.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":138.64,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":141.23,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":142.53,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":136.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":125.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":129.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":136.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":132.16,"methodology":"fee 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Plan","plan_name":"MCR","standard_charge_dollar":702.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":675.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":675.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":728.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":708.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":728.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":708.69,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":721.94,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":728.56,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":695.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":642.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":662.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":695.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":675.58,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":662.33,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, suction suspension, above knee or knee disarticulation socket ","code_information":[{"code":"L5652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":495.69,"maximum":562.12,"payers_information":[{"payer_name":"Aetna 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The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":993.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":956.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":956.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":1030.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":1002.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1030.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1002.86,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":1021.60,"methodology":"fee 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","code_information":[{"code":"L5783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2925.44,"maximum":3317.51,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":3227.03,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":3106.40,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":3317.51,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3196.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":3076.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":3076.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":3317.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":3227.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3317.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3227.03,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":3287.35,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3317.51,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3166.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2925.44,"methodology":"fee 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":13814.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13946.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7982.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10087.09,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7982.89,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":13288.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":13288.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10596.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24017.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10596.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7982.89,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":13156.96,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13703.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":14472.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":29619.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47311.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13156.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13551.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13156.96,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. 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schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":23.19,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":22.74,"methodology":"fee schedule"}]}]},{"description":"Dactinomycin injection ","code_information":[{"code":"752","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":282.13,"maximum":310.35,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":282.13,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":301.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":290.60,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":310.35,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":299.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":287.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":287.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":310.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":301.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":310.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":301.88,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":307.52,"methodology":"fee 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"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7994.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10101.18,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7994.04,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":6566.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":6566.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10611.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24050.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10611.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7994.04,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":6501.57,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6771.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":7151.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":14636.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":23379.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":6501.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6696.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":12887.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12320.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":343.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of 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","code_information":[{"code":"690475","type":"CDM"},{"code":"85307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.89,"maximum":19.15,"gross_charge":147.37,"discounted_cash":147.37,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":7.80,"standard_charge_algorithm":"Reimbursement will be 7.8% of billable gross 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","plan_name":"MCR","standard_charge_dollar":92.02,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":98.46,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":101.22,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":97.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":93.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":93.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":101.22,"methodology":"fee schedule"},{"payer_name":"Cigna 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","code_information":[{"code":"97032","type":"CPT"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":12.01,"maximum":13.21,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":13.21,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":81076.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":81848.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20274.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":109182.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":137961.90,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":109182.59,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":77987.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":77987.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":144930.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":328484.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":144930.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":109182.59,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":77215.73,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":80423.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":84937.30,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":173832.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":277665.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":77215.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":79532.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. 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"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13449.72,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":13449.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12857.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5841.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7381.83,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5841.95,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":9947.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":9947.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":7754.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17576.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":7754.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5841.95,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":9849.47,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10258.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":10834.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":22173.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35418.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9849.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10144.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9849.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":9947.96,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":10735.92,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9238.80,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9553.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10440.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","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":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12311.84,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":9947.96,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":9947.96,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":9947.96,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11806.58,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"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":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":10341.94,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11671.62,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":9849.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9416.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":9849.47,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":9652.48,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, foam filled caster tire, any size, replacement only, each ","code_information":[{"code":"E2387","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":56.55,"maximum":64.13,"payers_information":[{"payer_name":"Aetna 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","code_information":[{"code":"L8440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":59.61,"maximum":67.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":61.45,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":65.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":63.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":67.60,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":65.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":62.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":62.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":67.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":65.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":67.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":65.75,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":66.98,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":67.60,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":64.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":59.61,"methodology":"fee 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"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":18372.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10422.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10734.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":4674.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4468.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":18.77,"methodology":"fee schedule"}]}]},{"description":"Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment ","code_information":[{"code":"L3975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1754.60,"maximum":1989.76,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1808.87,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":1935.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":1863.14,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":1989.76,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1917.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":1845.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":1845.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":1989.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":1935.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1989.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1935.49,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":1971.67,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":1989.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":1899.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":1754.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":1808.87,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":1899.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":1845.05,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":1808.87,"methodology":"fee schedule"}]}]},{"description":"SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A) (eg, Prader-Willi syndrome and/or Angelman syndrome), methylation analysis ","code_information":[{"code":"81331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51.07,"maximum":63.84,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":51.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":7.80,"standard_charge_algorithm":"Reimbursement will be 7.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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State","plan_name":"MCR","standard_charge_dollar":53.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":52.09,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":51.07,"methodology":"fee schedule"}]}]},{"description":"Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens ","code_information":[{"code":"V2107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":55.93,"maximum":63.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":57.66,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":61.70,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":63.43,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":61.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":58.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":58.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":63.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":61.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":63.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":61.70,"methodology":"fee 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","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":860.00,"maximum":32390.14,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":9007.35,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9097.43,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":9007.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":9457.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9547.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10549.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13330.33,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10549.58,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":9097.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":9097.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14003.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":31739.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14003.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10549.58,"methodology":"fee schedule"},{"payer_name":"BeHealthy America","plan_name":"MCR","standard_charge_dollar":9007.35,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":9381.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":9908.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":20277.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":32390.14,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9007.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9277.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","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":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9007.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":9097.43,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":9818.02,"methodology":"fee schedule"},{"payer_name":"Healthcare Sarasota","plan_name":"COMM","standard_charge_dollar":860.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":8448.90,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8737.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":9547.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","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":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":11259.19,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":9097.43,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":9097.43,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":9097.43,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10797.14,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"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":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":9457.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":10673.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":9007.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8611.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":9007.35,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":8827.21,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type ","code_information":[{"code":"L5857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9793.70,"maximum":11106.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10096.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":10803.36,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":10399.50,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":11106.26,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10702.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":10298.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":10298.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":11106.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10803.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11106.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10803.36,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":11005.29,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":11106.26,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10601.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9793.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":10096.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":10601.43,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10298.53,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":10096.60,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each ","code_information":[{"code":"L2622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":327.26,"maximum":371.12,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":337.38,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":361.00,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":347.50,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":371.12,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":357.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":344.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":344.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":371.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":361.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":371.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":361.00,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":367.74,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":371.12,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":354.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":327.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":337.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":354.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":344.13,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":337.38,"methodology":"fee schedule"}]}]},{"description":"Addition to terminal device, precision pinch device 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