{"hospital_name":"HCA FLORIDA WOODMONT HOSPITAL","last_updated_on":"2024-10-01","version":"2.2.0","affirmation":{"affirmation":"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.","confirm_affirmation":true},"hospital_location":["HCA FLORIDA WOODMONT HOSPITAL"],"hospital_address":["7201 N. 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm ","code_information":[{"code":"11603","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm ","code_information":[{"code":"11604","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm ","code_information":[{"code":"11606","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Excision, nasal polyp(s), extensive ","code_information":[{"code":"30115","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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rate"}]}]},{"description":"Excision, nasal polyp(s), simple ","code_information":[{"code":"30110","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm ","code_information":[{"code":"11441","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm ","code_information":[{"code":"11442","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm ","code_information":[{"code":"11443","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm ","code_information":[{"code":"11444","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm ","code_information":[{"code":"11444","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm ","code_information":[{"code":"11444","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm ","code_information":[{"code":"11446","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Excision, prepatellar bursa ","code_information":[{"code":"27340","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Excision, radial head ","code_information":[{"code":"24130","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; ","code_information":[{"code":"15936","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Excision, sacral pressure ulcer, with primary suture; ","code_information":[{"code":"15931","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Excision, sacral pressure ulcer, with primary suture; with ostectomy ","code_information":[{"code":"15933","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Excision, sacral pressure ulcer, with primary suture; with ostectomy ","code_information":[{"code":"15933","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth 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rate"}]}]},{"description":"Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy ","code_information":[{"code":"15958","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case 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","code_information":[{"code":"15951","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Excision, 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","code_information":[{"code":"26593","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Release, tarsal tunnel (posterior tibial nerve decompression) ","code_information":[{"code":"28035","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"RELOAD STAPLE 60MM BLUE ","code_information":[{"code":"803824","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1477.00,"discounted_cash":1477.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross 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charges.","estimated_amount":265.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":369.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":398.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":398.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":398.79,"methodology":"percent 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charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":738.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":738.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":398.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":357.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.40,"standard_charge_algorithm":"Reimbursement will be 13.4% of billable gross charges.","estimated_amount":197.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.70,"standard_charge_algorithm":"Reimbursement will be 10.7% of billable gross charges.","estimated_amount":158.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":79.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":78.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":262.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":357.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":262.91,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":738.50,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options 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charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":293.92,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":738.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1181.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":236.32,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":137.36,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":339.71,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":310.17,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":502.18,"methodology":"percent of total billed 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charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1181.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1255.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":738.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":199.40,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2141.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":420.94,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":664.65,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":373.68,"methodology":"percent of total billed charges"}]}]},{"description":"Relocation of skin pocket for implantable defibrillator ","code_information":[{"code":"33223","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":49575.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":31068.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":49575.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":22936.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":27216.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":32371.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":30246.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":18208.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":5583.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":4783.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":3633.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":4730.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":5583.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":4730.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":23814.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":4575.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":3850.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22228.00,"methodology":"case rate"}]}]},{"description":"REM CALC/DEB PERC BIL ","code_information":[{"code":"791972","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4182.25,"discounted_cash":4182.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":313.67,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":752.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1129.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1129.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1129.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1129.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1129.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":225.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":221.66,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.13,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":4182.25,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":543.69,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":4809.59,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.13,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3345.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":669.16,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":388.95,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":961.92,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":961.92,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1129.21,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":794.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3554.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3136.69,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":388.95,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.13,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3345.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3554.91,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2091.13,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":564.60,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":6064.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1882.01,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1058.11,"methodology":"percent of total billed charges"}]}]},{"description":"Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation ","code_information":[{"code":"499","type":"RC"},{"code":"50385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation ","code_information":[{"code":"369","type":"RC"},{"code":"50386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7054.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected ti ","code_information":[{"code":"54411","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":32890.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32890.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":28256.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of externally accessible nephroureteral catheter (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation ","code_information":[{"code":"360","type":"RC"},{"code":"50387","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session ","code_information":[{"code":"360","type":"RC"},{"code":"53447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":21832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":21832.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":18491.00,"methodology":"case rate"}]}]},{"description":"REMOVAL AND REPLACEMENT OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA, PULSE GENERATOR ONLY ","code_information":[{"code":"0431T","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":13594.00,"maximum":13833.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case 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The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32890.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":28256.00,"methodology":"case rate"}]}]},{"description":"Removal and replacement of permanent cardiac contractility modulation system pulse generator only ","code_information":[{"code":"0414T","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":14099.00,"maximum":79422.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":79422.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":66569.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from deep penile tissue (eg, plastic implant) ","code_information":[{"code":"369","type":"RC"},{"code":"54115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body from external auditory canal; with general anesthesia ","code_information":[{"code":"69205","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; by lateral rhinotomy ","code_information":[{"code":"30320","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; by lateral rhinotomy ","code_information":[{"code":"30320","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal of embedded foreign body, vestibule of mouth; simple ","code_information":[{"code":"369","type":"RC"},{"code":"40804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Removal of esophageal sphincter augmentation device ","code_information":[{"code":"369","type":"RC"},{"code":"43285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) ","code_information":[{"code":"20680","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system 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rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":83819.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":72009.00,"methodology":"case rate"}]}]},{"description":"Removal of implantable defibrillator pulse generator with replacement of 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incision ","code_information":[{"code":"0447T","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new implantable sensor, including system activation ","code_information":[{"code":"0448T","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal of implanted intra-arterial infusion pump ","code_information":[{"code":"361","type":"RC"},{"code":"36262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Removal of implanted material, posterior segment; extraocular ","code_information":[{"code":"369","type":"RC"},{"code":"67120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case 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","code_information":[{"code":"19328","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":13320.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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","code_information":[{"code":"499","type":"RC"},{"code":"66930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Removal of 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","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of permanent transvenous electrode(s) by thoracotomy ","code_information":[{"code":"33238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":32371.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":27216.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":32371.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement 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Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (List separately in addition to code for primary ","code_information":[{"code":"11008","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy) ","code_information":[{"code":"66830","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"33243","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3792.00,"maximum":49575.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":31068.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":49575.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":22936.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":27216.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":32371.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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(in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed ","code_information":[{"code":"499","type":"RC"},{"code":"63661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"63662","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of subcutaneous implantable defibrillator electrode ","code_information":[{"code":"33272","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":83819.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":83819.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":72009.00,"methodology":"case rate"}]}]},{"description":"Removal of sutures or staples 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of synthetic rod and insertion of flexor tendon graft, hand or finger (includes obtaining graft), each rod ","code_information":[{"code":"26392","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case 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","code_information":[{"code":"369","type":"RC"},{"code":"69970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Removal of tunneled intraperitoneal catheter ","code_information":[{"code":"481","type":"RC"},{"code":"49422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal ","code_information":[{"code":"361","type":"RC"},{"code":"67005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case 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","code_information":[{"code":"481","type":"RC"},{"code":"67005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal or revision of sling for stress incontinence (eg, fascia or synthetic) ","code_information":[{"code":"369","type":"RC"},{"code":"57287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal with reinsertion, non-biodegradable drug delivery implant ","code_information":[{"code":"11983","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal, implantable contraceptive capsules ","code_information":[{"code":"11976","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Removal, under anesthesia, of external fixation system ","code_information":[{"code":"20694","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case 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","code_information":[{"code":"499","type":"RC"},{"code":"50200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Renal biopsy; percutaneous, by trocar or needle ","code_information":[{"code":"50200","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculu ","code_information":[{"code":"50561","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom 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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":5916.51,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":5638.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED ","code_information":[{"code":"49561","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated ","code_information":[{"code":"361","type":"RC"},{"code":"49507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated ","code_information":[{"code":"481","type":"RC"},{"code":"49507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Repair initial inguinal hernia, age 5 years or older; reducible ","code_information":[{"code":"49505","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Repair lateral collateral ligament, elbow, with local tissue ","code_information":[{"code":"24343","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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","code_information":[{"code":"360","type":"RC"},{"code":"40654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Repair of defect with autograft; radius OR ulna ","code_information":[{"code":"25425","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":0.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":1.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.40,"standard_charge_algorithm":"Reimbursement will be 13.4% of billable gross charges.","estimated_amount":0.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.70,"standard_charge_algorithm":"Reimbursement will be 10.7% of billable gross charges.","estimated_amount":0.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":0.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":0.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":1.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":1.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":1.07,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":6.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":0.78,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":6.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1.19,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":0.96,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":0.56,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1.38,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":1.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1.62,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":0.56,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":0.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health 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charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1.52,"methodology":"percent of total billed charges"}]}]},{"description":"Construction of artificial vagina; with graft ","code_information":[{"code":"481","type":"RC"},{"code":"57292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Construction of artificial vagina; with graft ","code_information":[{"code":"490","type":"RC"},{"code":"57292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case 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","code_information":[{"code":"360","type":"RC"},{"code":"67830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) ","code_information":[{"code":"28285","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) ","code_information":[{"code":"28285","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health 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","code_information":[{"code":"28285","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case 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"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10047.69,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":9879.01,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":9417.38,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":18462.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11784.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9816.30,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":9325.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9325.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13475.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18462.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13475.88,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8791.60,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":9325.05,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":9232.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10156.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":14101.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":20051.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":9509.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9417.38,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":9602.03,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9417.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":9786.69,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":10340.65,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":9602.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9048.07,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8955.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9879.01,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1150.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":9786.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":9786.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11540.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7149.82,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":9325.05,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":9602.03,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":9694.36,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":10156.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9879.01,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":9232.72,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":8798.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":21.60,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":15.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":68.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":60.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":7.44,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":10.40,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":40.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":64.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime 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charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":22.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":36.00,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":20.24,"methodology":"percent of total billed charges"}]}]},{"description":"CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; known familial variant(s) ","code_information":[{"code":"81190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183.35,"maximum":277.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":190.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.80,"standard_charge_algorithm":"Reimbursement will be 9.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, multiple compartments; with debridement of nonviable muscle and/or nerve ","code_information":[{"code":"27499","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"369","type":"RC"},{"code":"69960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Decompression of orbit only, transcranial approach 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Decompressive fasciotomy, hand (excludes 26035) ","code_information":[{"code":"26037","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health 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"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7612.88,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":7818.05,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":7744.98,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":8183.38,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":7598.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":7160.46,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":7087.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7818.05,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1150.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":7744.98,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":7744.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9133.24,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5417.24,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":7379.65,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":7598.85,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":7671.92,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":8037.25,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7818.05,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":7306.59,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":6963.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7801 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":7306.59,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":7306.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7087.39,"methodology":"fee schedule"}]}]},{"description":"DEF DRUG SUBSTANCE 1-3 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billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":101.06,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":12.53,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":17.52,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":67.38,"methodology":"percent of total billed 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billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":195.39,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":38.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":60.64,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":34.09,"methodology":"percent of 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procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Denervation, hip joint, intrapelvic or extrapelvic intra-articular branches of sciatic, femoral, or obturator nerves ","code_information":[{"code":"27035","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Dermabrasion; segmental, face ","code_information":[{"code":"15781","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for 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","code_information":[{"code":"15783","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case 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rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addi ","code_information":[{"code":"17003","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case 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Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body, external eye; corneal, without slit lamp ","code_information":[{"code":"490","type":"RC"},{"code":"65220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body, foot; subcutaneous ","code_information":[{"code":"28190","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body, pelvis or hip; subcutaneous tissue ","code_information":[{"code":"27086","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body, upper arm or elbow area; deep (subfascial or intramuscular) ","code_information":[{"code":"24201","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body, upper arm or elbow area; subcutaneous ","code_information":[{"code":"24200","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) ","code_information":[{"code":"20680","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system ","code_information":[{"code":"33263","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":83819.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case 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rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":83819.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":72009.00,"methodology":"case rate"}]}]},{"description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system ","code_information":[{"code":"33262","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":83819.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Bright Health 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","code_information":[{"code":"65920","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Removal of implanted material, posterior segment; intraocular ","code_information":[{"code":"369","type":"RC"},{"code":"67121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of lens material; aspiration technique, 1 or more stages ","code_information":[{"code":"360","type":"RC"},{"code":"66840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case 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","code_information":[{"code":"490","type":"RC"},{"code":"66930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA; PULSE GENERATOR ONLY ","code_information":[{"code":"0428T","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REMOVAL OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA; STIMULATION LEAD ONLY ","code_information":[{"code":"0430T","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Removal of peritoneal-venous shunt ","code_information":[{"code":"481","type":"RC"},{"code":"49429","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of permanent cardiac contractility modulation system; pulse generator only ","code_information":[{"code":"0412T","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of prosthesis, includes debridement and synovectomy when performed; humeral and ulnar components ","code_information":[{"code":"24160","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of prosthesis, includes debridement and synovectomy when performed; humeral and ulnar components ","code_information":[{"code":"24160","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of prosthesis, includes debridement and synovectomy when performed; radial head ","code_information":[{"code":"24164","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel) ","code_information":[{"code":"19330","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy) ","code_information":[{"code":"361","type":"RC"},{"code":"66830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions ","code_information":[{"code":"11200","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed ","code_information":[{"code":"369","type":"RC"},{"code":"63661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal of tissue expander without insertion of implant ","code_information":[{"code":"11971","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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","code_information":[{"code":"53442","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Removal, 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","code_information":[{"code":"11982","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal, under anesthesia, of external fixation system ","code_information":[{"code":"20694","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom 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","code_information":[{"code":"499","type":"RC"},{"code":"50555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":7695.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Renal 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus ","code_information":[{"code":"50580","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":7695.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case 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adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel with vein graft; lower extremity ","code_information":[{"code":"35256","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case 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rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); REDUCIBLE (SEPARATE PROCEDURE) ","code_information":[{"code":"49570","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Repair inguinal hernia, sliding, any age ","code_information":[{"code":"49525","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth 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logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE ","code_information":[{"code":"361","type":"RC"},{"code":"49560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"}]}]},{"description":"Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; incarcerated or strangulated ","code_information":[{"code":"49501","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible ","code_information":[{"code":"49500","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case 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rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Repair lumbar hernia ","code_information":[{"code":"361","type":"RC"},{"code":"49540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case 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","code_information":[{"code":"24345","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Repair medial collateral ligament, elbow, with local tissue ","code_information":[{"code":"24345","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator ","code_information":[{"code":"33220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":49575.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":31068.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":49575.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":22936.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":27216.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":32371.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":16172.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14014.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11277.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14534.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16172.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14534.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":23814.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":4575.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":3850.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22228.00,"methodology":"case rate"}]}]},{"description":"Repair of anorectal fistula with plug (eg, porcine small intestine submucosa ºSIS») ","code_information":[{"code":"46707","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health 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2.5 cm ","code_information":[{"code":"13131","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, trunk; 1.1 cm to 2.5 cm ","code_information":[{"code":"13100","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3346.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Repair, complex, trunk; each additional 5 cm or less (List separately in addition to code for primary procedure) ","code_information":[{"code":"13102","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Repair, dislocating peroneal tendons; with fibular osteotomy ","code_information":[{"code":"27676","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health 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procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Repair, extensor tendon, leg; secondary, with or without graft, each tendon ","code_information":[{"code":"27665","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright 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Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm ","code_information":[{"code":"12055","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less ","code_information":[{"code":"12051","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case 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rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm ","code_information":[{"code":"12045","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less ","code_information":[{"code":"12041","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less ","code_information":[{"code":"12041","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm ","code_information":[{"code":"12044","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm ","code_information":[{"code":"12044","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case 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","code_information":[{"code":"12031","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; collateral ","code_information":[{"code":"27405","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case 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","code_information":[{"code":"27409","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case 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logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Repair, secondary, Achilles tendon, with or without graft ","code_information":[{"code":"27654","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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","code_information":[{"code":"25272","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle ","code_information":[{"code":"25263","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case 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","code_information":[{"code":"28210","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon ","code_information":[{"code":"28200","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case 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","code_information":[{"code":"30450","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case 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logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Rhytidectomy; cheek, chin, and neck ","code_information":[{"code":"15828","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap ","code_information":[{"code":"15829","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1506.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1506.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1506.33,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1227.38,"methodology":"percent of total billed 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charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1506.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":1350.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.40,"standard_charge_algorithm":"Reimbursement will be 13.4% of billable gross charges.","estimated_amount":747.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.70,"standard_charge_algorithm":"Reimbursement will be 10.7% of billable gross charges.","estimated_amount":596.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS 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","code_information":[{"code":"37186","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"SECTION RECURRENT LARYNGEAL NERVE, THERAPEUTIC (SEPARATE PROCEDURE), UNILATERAL ","code_information":[{"code":"31595","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"SEIZURES 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"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8883.30,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":8893.41,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":8477.83,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":17633.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11255.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9375.62,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":8394.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8394.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12870.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17633.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12870.91,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7772.77,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":8394.71,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":8311.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9142.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":12467.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":17727.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":8560.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8477.83,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":8644.06,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8477.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":8810.29,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":9308.99,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":8644.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":8145.36,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8062.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8893.41,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1150.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":8810.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":8810.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10389.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6321.25,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":8394.71,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":8644.06,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":8727.18,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":9142.76,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8893.41,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":8311.60,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":7920.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7801 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8311.60,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":8311.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8062.25,"methodology":"fee schedule"}]}]},{"description":"Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code ","code_information":[{"code":"361","type":"RC"},{"code":"36248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial seco ","code_information":[{"code":"36218","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family ","code_information":[{"code":"360","type":"RC"},{"code":"36246","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth 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abdominal, pelvic, or lower extremity artery branch, within a vascular family ","code_information":[{"code":"36247","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological su ","code_information":[{"code":"36228","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological su ","code_information":[{"code":"36228","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, external carotid artery, unilateral, with angiography of the ipsilateral external carotid circulation and all associated radiological supervision and interpretation (List ","code_information":[{"code":"360","type":"RC"},{"code":"36227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom 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further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable muscle and/or nerve ","code_information":[{"code":"27892","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, leg; posterior compartment(s) only, with debridement of nonviable muscle and/or nerve ","code_information":[{"code":"27893","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case 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rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); with debridement of nonviable muscle and/or nerve ","code_information":[{"code":"27497","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); with debridement of nonviable muscle and/or nerve ","code_information":[{"code":"27497","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth 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rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed ","code_information":[{"code":"31276","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus ","code_information":[{"code":"31267","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case 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","code_information":[{"code":"31294","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12056.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with optic nerve decompression ","code_information":[{"code":"31294","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":12056.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus ","code_information":[{"code":"31288","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Nasal/sinus endoscopy, surgical; with concha bullosa resection ","code_information":[{"code":"31240","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage ","code_information":[{"code":"31238","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"874997","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1477.00,"discounted_cash":1477.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":243.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":110.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":282.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 13.8% of billable gross charges.","estimated_amount":203.83,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":265.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":369.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":398.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross 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treatment of coccygeal fracture ","code_information":[{"code":"27202","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case 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","code_information":[{"code":"21360","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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","code_information":[{"code":"21462","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple ","code_information":[{"code":"490","type":"RC"},{"code":"52310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case 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rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with resection of ureteral or renal pelvic tumor ","code_information":[{"code":"490","type":"RC"},{"code":"52355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth 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dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Cystourethroscopy; with incision or resection of orifice of bladder diverticulum, single or multiple ","code_information":[{"code":"52305","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health 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rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Cystourethroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision) ","code_information":[{"code":"369","type":"RC"},{"code":"52341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2867.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health 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charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":100.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":108.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":108.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":108.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":108.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":88.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":52.45,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":201.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":201.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":201.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":108.94,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":201.75,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":403.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":52.45,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":464.02,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":201.75,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":322.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":64.56,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":37.53,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":92.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":84.73,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":137.19,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":92.81,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":108.94,"methodology":"percent of total billed 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","code_information":[{"code":"27892","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, leg; posterior compartment(s) only ","code_information":[{"code":"27601","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); with debridement of nonviable muscle and/or nerve ","code_information":[{"code":"27497","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, multiple compartments; ","code_information":[{"code":"27498","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Decompression internal auditory canal ","code_information":[{"code":"361","type":"RC"},{"code":"69960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case 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","code_information":[{"code":"32225","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13042.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7198.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips ","code_information":[{"code":"15630","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet ","code_information":[{"code":"15620","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Delayed creation of exit site from embedded subcutaneous segment of intraperitoneal cannula or catheter ","code_information":[{"code":"49436","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case 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"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":9065.48,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":9047.61,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":8624.83,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":20148.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12861.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10712.64,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":8540.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8540.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14706.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20148.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14706.38,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7932.18,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":8540.27,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":8455.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9301.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":12723.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":18091.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":8709.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8624.83,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":8793.94,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8624.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":8963.05,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":9470.40,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":8793.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":8286.60,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8202.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9047.61,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1150.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":8963.05,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":8963.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10569.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6450.89,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":8540.27,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":8793.94,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":8878.50,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":9301.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9047.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":8455.71,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":8058.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children ","code_information":[{"code":"15136","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Dermal injection procedure(s) for facial lipodystrophy syndrome (lds) and provision of radiesse or sculptra dermal filler, including all items and supplies ","code_information":[{"code":"361","type":"RC"},{"code":"C9800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":4910.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"}]}]},{"description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous 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rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for p ","code_information":[{"code":"360","type":"RC"},{"code":"64636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus ","code_information":[{"code":"369","type":"RC"},{"code":"64681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case 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","code_information":[{"code":"17106","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case 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","code_information":[{"code":"46924","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case 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rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation ","code_information":[{"code":"46910","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision ","code_information":[{"code":"46922","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"499","type":"RC"},{"code":"54050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation ","code_information":[{"code":"499","type":"RC"},{"code":"54055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case 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","code_information":[{"code":"361","type":"RC"},{"code":"56501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Destruction of lesion, conjunctiva ","code_information":[{"code":"490","type":"RC"},{"code":"68135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health 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rate"}]}]},{"description":"Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy, second eye, at single session (List separately in addition to code for primary eye treatment) ","code_information":[{"code":"499","type":"RC"},{"code":"67225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Destruction of localized lesion of choroid (for example, choroidal neovascularization); photocoagulation, feeder vessel technique (one or more sessions) ","code_information":[{"code":"490","type":"RC"},{"code":"G0186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth 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rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"17282","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm ","code_information":[{"code":"17284","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm ","code_information":[{"code":"17271","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm ","code_information":[{"code":"17274","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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rate"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"17262","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm ","code_information":[{"code":"17266","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"DEVICE CATH GD 50X106CM ","code_information":[{"code":"811985","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":15081.00,"discounted_cash":15081.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":2488.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2880.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 13.8% of billable gross charges.","estimated_amount":2081.18,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2714.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3770.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":4071.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":4071.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":4071.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":4071.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":3317.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1960.53,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7540.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7540.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross 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further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Diagnostic bone marrow; biopsy(ies) ","code_information":[{"code":"369","type":"RC"},{"code":"38221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation neces ","code_information":[{"code":"36909","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"DIALYSIS SLEDD ","code_information":[{"code":"796026","type":"CDM"},{"code":"90945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":4577.00,"discounted_cash":4577.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":755.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":874.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 13.8% of billable gross charges.","estimated_amount":631.63,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":823.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1144.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1235.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1235.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1235.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1235.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1006.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":595.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2288.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2288.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2288.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1235.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":1107.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.40,"standard_charge_algorithm":"Reimbursement will be 13.4% of billable gross charges.","estimated_amount":613.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.70,"standard_charge_algorithm":"Reimbursement will be 10.7% of billable gross charges.","estimated_amount":489.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":247.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":242.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":814.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":1107.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":814.71,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2288.50,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":4577.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":595.01,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":5263.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1011.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":910.82,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2288.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3661.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":732.32,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":425.66,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1052.71,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":961.17,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1556.18,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1052.71,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1235.79,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":869.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3890.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3432.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":425.66,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":595.01,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2288.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3661.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3890.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2288.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":617.89,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":6636.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1304.44,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2059.65,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1157.98,"methodology":"percent of total billed charges"}]}]},{"description":"Dilation and curettage of cervical stump ","code_information":[{"code":"490","type":"RC"},{"code":"57558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Dilation of cervical canal, instrumental (separate procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"57800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Dilation of esophagus, over guide wire ","code_information":[{"code":"360","type":"RC"},{"code":"43453","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Dilation of female urethra including suppository and/or instillation; initial ","code_information":[{"code":"499","type":"RC"},{"code":"53660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Dilation of female urethra including suppository and/or instillation; subsequent ","code_information":[{"code":"499","type":"RC"},{"code":"53661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case 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charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":121.74,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":301.07,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":274.89,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":445.06,"methodology":"percent of total billed 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billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1898.05,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":373.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":589.05,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":331.18,"methodology":"percent of 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charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":199.40,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2141.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":420.94,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross 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"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":16236.90,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":15117.91,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":14411.47,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":21918.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13991.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11653.95,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":14270.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14270.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":15998.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":21918.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":15998.62,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":14207.07,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":14270.18,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":14128.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15541.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":22787.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":32403.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":14552.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14411.47,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":14694.05,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14411.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":14976.62,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":15824.36,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":14694.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":13846.31,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":13705.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15117.91,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1150.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":14976.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":14976.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17661.11,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11553.99,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":14270.18,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":14694.05,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":14835.33,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":15541.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15117.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":14128.89,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":13464.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7801 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":14128.89,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":14128.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13705.02,"methodology":"fee schedule"}]}]},{"description":"Displacement therapy (Proetz type) ","code_information":[{"code":"30210","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach ","code_information":[{"code":"369","type":"RC"},{"code":"43130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach ","code_information":[{"code":"43130","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for myelography and/or computed tomography, lumbar ","code_information":[{"code":"490","type":"RC"},{"code":"62284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom 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for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed ","code_information":[{"code":"27096","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Injection, anesthetic agent; superior hypogastric plexus ","code_information":[{"code":"64517","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Injection, anterior chamber of eye (separate procedure); medication ","code_information":[{"code":"369","type":"RC"},{"code":"66030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Injection, anterior chamber of eye (separate procedure); medication ","code_information":[{"code":"481","type":"RC"},{"code":"66030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Injection, intralesional; more than 7 lesions ","code_information":[{"code":"11901","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Injection, intralesional; up to and including 7 lesions ","code_information":[{"code":"11900","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel ","code_information":[{"code":"20526","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel ","code_information":[{"code":"20526","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic ","code_information":[{"code":"369","type":"RC"},{"code":"62281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic ","code_information":[{"code":"481","type":"RC"},{"code":"62281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal) ","code_information":[{"code":"360","type":"RC"},{"code":"62282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal) ","code_information":[{"code":"369","type":"RC"},{"code":"62282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"INS GASTRO TUBE PERC ","code_information":[{"code":"116176","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3489.25,"discounted_cash":3489.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":261.69,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":628.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":942.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":942.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":942.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":942.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1744.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1744.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1744.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":942.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":188.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":184.93,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1744.63,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":3489.25,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":453.60,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":4012.64,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1744.63,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2791.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":558.28,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":324.50,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":802.53,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":802.53,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":942.10,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":662.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2965.86,"methodology":"percent of total billed 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charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2965.86,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1744.63,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":471.05,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5059.41,"methodology":"percent 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rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32890.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":28256.00,"methodology":"case rate"}]}]},{"description":"Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir ","code_information":[{"code":"499","type":"RC"},{"code":"54405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":32890.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32890.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":28256.00,"methodology":"case rate"}]}]},{"description":"Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular ","code_information":[{"code":"33207","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":49575.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":31068.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":49575.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":22936.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":27216.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":32371.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":16172.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14014.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11277.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14534.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16172.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14534.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":23814.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":4575.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":3850.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22228.00,"methodology":"case rate"}]}]},{"description":"Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine) ","code_information":[{"code":"369","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine) ","code_information":[{"code":"481","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine) ","code_information":[{"code":"490","type":"RC"},{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older ","code_information":[{"code":"36556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":41198.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":23175.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":12926.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9920.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7623.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9763.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":12926.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9763.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8980.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":8010.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"}]}]},{"description":"Insertion of ocular implant secondary; after enucleation, muscles not attached to implant ","code_information":[{"code":"369","type":"RC"},{"code":"65135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Insertion of ocular implant secondary; after enucleation, muscles not attached to implant ","code_information":[{"code":"481","type":"RC"},{"code":"65135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Insertion of penile prosthesis; inflatable (self-contained) ","code_information":[{"code":"360","type":"RC"},{"code":"54401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":32890.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32890.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":28256.00,"methodology":"case rate"}]}]},{"description":"Insertion of penile prosthesis; inflatable (self-contained) ","code_information":[{"code":"369","type":"RC"},{"code":"54401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":32890.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32890.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":28256.00,"methodology":"case rate"}]}]},{"description":"Insertion of penile prosthesis; non-inflatable (semi-rigid) ","code_information":[{"code":"481","type":"RC"},{"code":"54400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":32890.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32890.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":28256.00,"methodology":"case rate"}]}]},{"description":"Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; age 5 years or older ","code_information":[{"code":"36569","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":41198.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":17846.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":20326.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":13175.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":23175.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":5583.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":4783.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":3633.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":4730.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":5583.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":4730.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8980.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":8010.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"}]}]},{"description":"Insertion of peritoneal-venous shunt ","code_information":[{"code":"360","type":"RC"},{"code":"49425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Insertion of peritoneal-venous shunt ","code_information":[{"code":"49425","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Insertion of sinus tarsi implant ","code_information":[{"code":"0335T","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4997.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Insertion of subcutaneous extension to intraperitoneal cannula or catheter with remote chest exit site (List separately in addition to code for primary procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"49435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Insertion of subcutaneous extension to intraperitoneal cannula or catheter with remote chest exit site (List separately in addition to code for primary procedure) ","code_information":[{"code":"49435","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Insertion of tandem cuff (dual cuff) ","code_information":[{"code":"360","type":"RC"},{"code":"53444","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15150.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13016.00,"methodology":"case 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rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Insertion of temporary indwelling bladder catheter; simple (eg, Foley) ","code_information":[{"code":"361","type":"RC"},{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older ","code_information":[{"code":"36558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":41198.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":17846.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":20326.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":13175.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":23175.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":12926.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9920.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7623.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9763.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":12926.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9763.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8980.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":8010.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"}]}]},{"description":"Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age ","code_information":[{"code":"36557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1950.00,"maximum":41198.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":10262.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":23175.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":16172.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14014.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11277.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14534.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16172.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14534.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8980.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":8010.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6243.00,"methodology":"case rate"}]}]},{"description":"Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, con ","code_information":[{"code":"49418","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Insertion of tunneled intraperitoneal catheter, with subcutaneous port (ie, totally implantable) ","code_information":[{"code":"369","type":"RC"},{"code":"49419","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Insertion of tunneled intraperitoneal catheter, with subcutaneous port (ie, totally implantable) ","code_information":[{"code":"481","type":"RC"},{"code":"49419","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Insertion of tunneled intraperitoneal catheter, with subcutaneous port (ie, totally implantable) ","code_information":[{"code":"490","type":"RC"},{"code":"49419","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy ","code_information":[{"code":"499","type":"RC"},{"code":"57155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":51417.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":51417.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":44171.00,"methodology":"case rate"}]}]},{"description":"Insertion of vascular pedicle into carpal bone (eg, Hori procedure) ","code_information":[{"code":"25430","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Insertion of vascular pedicle into carpal bone (eg, Hori procedure) ","code_information":[{"code":"25430","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":13853.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16336.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10600.58,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":13199.67,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":13591.74,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":13722.43,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":14375.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13983.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":13068.98,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":12454.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7801 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13068.98,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":13068.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12676.91,"methodology":"fee schedule"}]}]},{"description":"Creatine kinase (CK), (CPK); isoforms 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charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":299.30,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":752.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1203.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":240.64,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":139.87,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":345.92,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":315.84,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":511.36,"methodology":"percent of total billed 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billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2180.80,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":428.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":676.80,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":380.51,"methodology":"percent of 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charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":232.65,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":130.80,"methodology":"percent of total billed charges"}]}]},{"description":"Labyrinthectomy; transcanal ","code_information":[{"code":"361","type":"RC"},{"code":"69905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Labyrinthotomy, with perfusion of vestibuloactive drug(s), transcanal ","code_information":[{"code":"369","type":"RC"},{"code":"69801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Lactose, urine, qualitative ","code_information":[{"code":"83633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.14,"maximum":16.88,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross 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schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":11.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":11.31,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.25,"methodology":"fee schedule"}]}]},{"description":"Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar ","code_information":[{"code":"499","type":"RC"},{"code":"63277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":16546.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16546.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":14016.00,"methodology":"case rate"}]}]},{"description":"Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar ","code_information":[{"code":"369","type":"RC"},{"code":"63272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":16546.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16546.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":14016.00,"methodology":"case rate"}]}]},{"description":"Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracolumbar ","code_information":[{"code":"369","type":"RC"},{"code":"63252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":16546.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16546.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":14016.00,"methodology":"case rate"}]}]},{"description":"Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural ","code_information":[{"code":"481","type":"RC"},{"code":"63655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":67217.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":67217.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":57743.00,"methodology":"case rate"}]}]},{"description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical ","code_information":[{"code":"360","type":"RC"},{"code":"63001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except f ","code_information":[{"code":"63005","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; cervical ","code_information":[{"code":"481","type":"RC"},{"code":"63015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13594.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; lumbar ","code_information":[{"code":"63017","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13594.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Laminectomy with rhizotomy; more than 2 segments ","code_information":[{"code":"499","type":"RC"},{"code":"63190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":16546.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16546.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":14016.00,"methodology":"case rate"}]}]},{"description":"Laminectomy with section of spinal accessory nerve ","code_information":[{"code":"481","type":"RC"},{"code":"63191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":16546.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16546.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":14016.00,"methodology":"case rate"}]}]},{"description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve rootºs», ºeg, spinal or lateral recess stenosis»), single vertebral segm ","code_information":[{"code":"63045","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve rootºs», ºeg, spinal or lateral recess stenosis»), single vertebral segm ","code_information":[{"code":"361","type":"RC"},{"code":"63047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve rootºs», ºeg, spinal or lateral recess stenosis»), single vertebral segm ","code_information":[{"code":"63048","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Laminectomy, with release of tethered spinal cord, lumbar ","code_information":[{"code":"490","type":"RC"},{"code":"63200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":16546.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16546.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":14016.00,"methodology":"case rate"}]}]},{"description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each ","code_information":[{"code":"360","type":"RC"},{"code":"63043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each ","code_information":[{"code":"481","type":"RC"},{"code":"63044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case 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","code_information":[{"code":"43280","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) ","code_information":[{"code":"43775","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g ","code_information":[{"code":"58546","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11411.00,"methodology":"case 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INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED ","code_information":[{"code":"481","type":"RC"},{"code":"49657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10009.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10567.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED ","code_information":[{"code":"369","type":"RC"},{"code":"49653","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7695.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth 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billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":12835.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6652.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":16172.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14014.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11277.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14534.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16172.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14534.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":15158.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":4575.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":2250.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14501.00,"methodology":"case rate"}]}]},{"description":"Laparoscopy, surgical, with ligation of spermatic veins for varicocele ","code_information":[{"code":"490","type":"RC"},{"code":"55550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Laparoscopy, surgical; ablation of renal mass lesion(s), including intraoperative ultrasound guidance and monitoring, when performed ","code_information":[{"code":"360","type":"RC"},{"code":"50542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health 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rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":10847.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":12535.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":12483.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":14266.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy direct, with or without tracheoscopy; for aspiration ","code_information":[{"code":"31515","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1909.00,"maximum":4910.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy direct, with or without tracheoscopy; with dilation, initial ","code_information":[{"code":"31528","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom 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","code_information":[{"code":"31561","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; ","code_information":[{"code":"31540","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, direct, operative, with foreign body removal; with operating microscope or telescope ","code_information":[{"code":"31531","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, direct, operative, with operating microscope or 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rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s) 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope ","code_information":[{"code":"31571","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral ","code_information":[{"code":"31572","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, flexible; with biopsy(ies) ","code_information":[{"code":"31576","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, flexible; with removal of foreign body(s) ","code_information":[{"code":"31577","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3346.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, flexible; with removal of lesion(s), non-laser ","code_information":[{"code":"31578","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral ","code_information":[{"code":"31573","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Laryngoscopy, indirect; with removal of foreign body ","code_information":[{"code":"31511","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Laryngotomy (thyrotomy, laryngofissure), with removal of tumor or laryngocele, cordectomy ","code_information":[{"code":"31300","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal uret ","code_information":[{"code":"481","type":"RC"},{"code":"52649","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"LASER HOLM MAST 1000UM ","code_information":[{"code":"889830","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3306.00,"discounted_cash":3306.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":545.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":247.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":631.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 13.8% of billable gross charges.","estimated_amount":456.23,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":595.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":826.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":892.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":892.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":892.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":892.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":727.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":429.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1653.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1653.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1653.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":892.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":800.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.40,"standard_charge_algorithm":"Reimbursement will be 13.4% of billable gross charges.","estimated_amount":443.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.70,"standard_charge_algorithm":"Reimbursement will be 10.7% of billable gross charges.","estimated_amount":353.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":178.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":175.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":588.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":800.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":588.47,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1653.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":3306.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":429.78,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":3801.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":730.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":657.89,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1653.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2644.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":528.96,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":307.46,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":760.38,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":694.26,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1124.04,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":760.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":892.62,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":628.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2810.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2479.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":307.46,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":429.78,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1653.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2644.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2810.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1653.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":446.31,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4793.70,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":942.21,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1487.70,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":836.42,"methodology":"percent of total billed charges"}]}]},{"description":"Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transuret ","code_information":[{"code":"499","type":"RC"},{"code":"52648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Lateral canthopexy ","code_information":[{"code":"21282","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11940.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":10668.55,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":10167.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6954.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":7002.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8257.29,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4786.90,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":6671.89,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":6870.06,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":6936.12,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":7266.41,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7068.24,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":6605.83,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":6295.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7801 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":6605.83,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":6605.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6407.66,"methodology":"fee schedule"}]}]},{"description":"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND CO ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":35796.93,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10996.23,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":10942.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":11937.90,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":11478.99,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":10942.59,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":35796.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":22850.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19033.03,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":10835.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10835.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":26128.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":35796.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":26128.67,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10445.51,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":10835.31,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":10728.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11800.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16754.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":23823.79,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":11049.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10942.59,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":11157.15,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10942.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":11371.71,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":12015.39,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":11157.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":10513.47,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10406.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11478.99,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1150.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":11371.71,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"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":"MCR","standard_charge_dollar":9079.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10706.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6549.66,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":8651.17,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":8908.14,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":8993.79,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":9422.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9165.10,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":8565.52,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":8162.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7801 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8565.52,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":8565.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8308.55,"methodology":"fee schedule"}]}]},{"description":"MAMMAPLASTY, AUGMENTATION; WITHOUT PROSTHETIC IMPLANT ","code_information":[{"code":"19324","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8412.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"}]}]},{"description":"MAMMAPLASTY, AUGMENTATION; WITHOUT PROSTHETIC IMPLANT ","code_information":[{"code":"19324","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8412.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Manipulation, hip joint, requiring general anesthesia ","code_information":[{"code":"27275","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":558.38,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":1116.75,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":145.18,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":1284.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":246.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":222.23,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":558.38,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":893.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":178.68,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":103.86,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":256.85,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":234.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":379.69,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":256.85,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":301.52,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":212.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":949.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":837.56,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":103.86,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":145.18,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":558.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":893.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":949.24,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":558.38,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":150.76,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1619.29,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":318.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross 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rate"}]}]},{"description":"Manometric studies through ureterostomy or indwelling ureteral catheter ","code_information":[{"code":"499","type":"RC"},{"code":"50686","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case 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charges.","estimated_amount":158.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":79.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":78.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":262.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":357.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":262.91,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":738.50,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":1477.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":192.01,"methodology":"percent of total billed 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charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1181.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":236.32,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":137.36,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":339.71,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":310.17,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":502.18,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":339.71,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":398.79,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":280.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1255.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1107.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":137.36,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":192.01,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":738.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1181.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1255.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":738.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":199.40,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2141.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance including cont 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Mediastinoscopy; includes biopsy(ies) of mediastinal mass (eg, lymphoma), when performed ","code_information":[{"code":"361","type":"RC"},{"code":"39401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy ","code_information":[{"code":"67400","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only ","code_information":[{"code":"67405","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case 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","code_information":[{"code":"54530","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case 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charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":467.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":467.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":252.38,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":467.38,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":934.75,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":121.52,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":1074.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":206.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":186.02,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":467.38,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":747.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":149.56,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":86.93,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":214.99,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":196.30,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":317.81,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":214.99,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":252.38,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":177.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":794.54,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":701.06,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":86.93,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":121.52,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":467.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":747.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":794.54,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":467.38,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":126.19,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1355.39,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":266.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":420.64,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":236.49,"methodology":"percent of total billed charges"}]}]},{"description":"Ostectomy of sternum, partial ","code_information":[{"code":"21620","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":10981.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, calcaneus; ","code_information":[{"code":"28118","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, calcaneus; ","code_information":[{"code":"28118","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case 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(in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal (eg, Clayton type procedure) ","code_information":[{"code":"28114","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, complete excision; other metatarsal head (second, third or fourth) ","code_information":[{"code":"28112","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, complete excision; other metatarsal head (second, third or fourth) ","code_information":[{"code":"28112","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth 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Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, carpal bone, shortening ","code_information":[{"code":"25394","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) ","code_information":[{"code":"21208","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, humerus (eg, shortening or lengthening) (excluding 64876) ","code_information":[{"code":"24420","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7695.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, radius OR ulna; lengthening with autograft ","code_information":[{"code":"25391","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11411.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"BENIGN PROSTATIC HYPERTROPHY WITH MCC ","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":24296.99,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11188.50,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":11133.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12175.02,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":11679.70,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":11133.92,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":17639.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11259.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9378.62,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":11024.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11024.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12875.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17639.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12875.03,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10652.99,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":11024.77,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":10915.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12007.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":17087.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":24296.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":11243.08,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11133.92,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":11352.23,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11133.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":11570.55,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":12225.48,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":11352.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":10697.30,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10588.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11679.70,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1150.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":11570.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":11570.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13644.51,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8663.60,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":11024.77,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":11352.23,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":11461.39,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":12007.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11679.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":10915.61,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":10402.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7801 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":10915.61,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":10915.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10588.14,"methodology":"fee schedule"}]}]},{"description":"Biliary endoscopy, percutaneous via T-tube or other tract; with biopsy, single or multiple ","code_information":[{"code":"360","type":"RC"},{"code":"47553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Biopsy external auditory canal ","code_information":[{"code":"481","type":"RC"},{"code":"69105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"57500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth 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Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Biopsy of palate, uvula ","code_information":[{"code":"369","type":"RC"},{"code":"42100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Biopsy of spinal cord, percutaneous needle ","code_information":[{"code":"62269","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vaginal mucosa; simple (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"57100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Biopsy thyroid, percutaneous core needle ","code_information":[{"code":"361","type":"RC"},{"code":"60100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, i ","code_information":[{"code":"19086","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle; deep ","code_information":[{"code":"20205","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular) ","code_information":[{"code":"25066","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vertebral body, open; lumbar or cervical ","code_information":[{"code":"20251","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"BIT DRILL 3.2MM ","code_information":[{"code":"911165","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2686.00,"discounted_cash":2686.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":443.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":201.45,"methodology":"percent of total billed 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charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":876.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":876.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":876.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":473.04,"methodology":"percent of total billed 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charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":876.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1401.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":280.32,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":162.94,"methodology":"percent of total billed 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billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":162.94,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":227.76,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":876.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1401.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1489.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":876.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":236.52,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2540.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":499.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":788.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":443.26,"methodology":"percent of total billed charges"}]}]},{"description":"Bone graft with microvascular anastomosis; fibula ","code_information":[{"code":"20955","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":10981.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites ","code_information":[{"code":"31625","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign body ","code_information":[{"code":"31635","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, 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billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2305.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":453.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":715.50,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":402.27,"methodology":"percent of 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Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Placement of endorectal intracavitary applicator for high intensity brachytherapy ","code_information":[{"code":"750","type":"RC"},{"code":"C9725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"360","type":"RC"},{"code":"40700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":3774.25,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":490.65,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":4340.39,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1887.13,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3019.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":603.88,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":351.01,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":868.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of 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charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3208.11,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1887.13,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":509.52,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5472.66,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1698.41,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":954.89,"methodology":"percent of total billed charges"}]}]},{"description":"Pollicization of a digit ","code_information":[{"code":"26550","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming ","code_information":[{"code":"369","type":"RC"},{"code":"64566","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case 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","code_information":[{"code":"811520","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3935.00,"discounted_cash":3935.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":649.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":295.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":751.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 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total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1967.50,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":3935.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":511.55,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":4525.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":869.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":783.07,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1967.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3148.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":629.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":365.95,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":905.05,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":826.35,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1337.90,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":905.05,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1062.45,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":747.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3344.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2951.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":365.95,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":511.55,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1967.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3148.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3344.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1967.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":531.23,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5705.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1121.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1770.75,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":995.55,"methodology":"percent of total billed charges"}]}]},{"description":"Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation ","code_information":[{"code":"68816","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, laser) ","code_information":[{"code":"45320","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; photocoagulation ","code_information":[{"code":"369","type":"RC"},{"code":"67145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case 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","code_information":[{"code":"906989","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":45.00,"discounted_cash":45.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":7.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":8.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 13.8% of 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charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":10.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.40,"standard_charge_algorithm":"Reimbursement will be 13.4% of billable gross charges.","estimated_amount":6.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.70,"standard_charge_algorithm":"Reimbursement will be 10.7% of billable gross charges.","estimated_amount":4.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":2.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":8.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":10.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":8.01,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health 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charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":9.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":8.95,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":36.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":7.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":4.19,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":10.35,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":9.45,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":15.30,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":10.35,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.15,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":8.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":38.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":33.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":4.19,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.85,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":36.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":38.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":6.08,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":65.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":12.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":20.25,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":11.38,"methodology":"percent of total billed charges"}]}]},{"description":"Quadricepsplasty (eg, Bennett or Thompson type) ","code_information":[{"code":"27430","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10981.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9392.00,"methodology":"case rate"}]}]},{"description":"Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure) ","code_information":[{"code":"24149","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8412.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; less than 3 cm ","code_information":[{"code":"28046","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; 5 cm or greater ","code_information":[{"code":"23078","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Radical resection of tumor, proximal or middle phalanx of finger ","code_information":[{"code":"26260","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"REM NEPHROS TUBE W FL ","code_information":[{"code":"797720","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2056.50,"discounted_cash":2056.50,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":154.24,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":370.17,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":555.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":555.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":555.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":555.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1028.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1028.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1028.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":555.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":111.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":108.99,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1028.25,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":2056.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":267.35,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":2364.97,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1028.25,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1645.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":329.04,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":191.25,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":473.00,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":473.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":555.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":390.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1748.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1542.38,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":191.25,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1028.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1645.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1748.03,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1028.25,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":277.63,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2981.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":925.42,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":520.29,"methodology":"percent of total billed charges"}]}]},{"description":"Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of ","code_information":[{"code":"499","type":"RC"},{"code":"54417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":32890.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32890.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":28256.00,"methodology":"case rate"}]}]},{"description":"Removal foreign body, intranasal; office type procedure ","code_information":[{"code":"30300","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC EVENT RECORDER ","code_information":[{"code":"33284","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":4910.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"}]}]},{"description":"Removal of complete cerebrospinal fluid shunt system; without replacement ","code_information":[{"code":"490","type":"RC"},{"code":"62256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body from pharynx ","code_information":[{"code":"369","type":"RC"},{"code":"42809","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body, external eye; corneal, with slit lamp ","code_information":[{"code":"499","type":"RC"},{"code":"65222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Removal of foreign body, upper arm or elbow area; subcutaneous ","code_information":[{"code":"24200","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system ","code_information":[{"code":"33263","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":83819.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":15536.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":22599.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":24286.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":83819.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":72009.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with revision of tracheal or bronchial stent inserted at previous session (includes tracheal/bronchial dilation as req ","code_information":[{"code":"31638","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) ","code_information":[{"code":"31629","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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rate"}]}]},{"description":"BURR 25MM 5120071059 ","code_information":[{"code":"827566","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1385.00,"discounted_cash":1385.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":228.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":103.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":264.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.80,"standard_charge_algorithm":"Reimbursement will be 13.8% of billable gross charges.","estimated_amount":191.13,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":249.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":346.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":373.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":373.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":373.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":373.95,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":304.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":180.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":692.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":692.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":692.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":373.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":335.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.40,"standard_charge_algorithm":"Reimbursement will be 13.4% of billable gross charges.","estimated_amount":185.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.70,"standard_charge_algorithm":"Reimbursement will be 10.7% of billable gross charges.","estimated_amount":148.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS 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charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":723.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":390.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":350.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.40,"standard_charge_algorithm":"Reimbursement will be 13.4% of billable gross charges.","estimated_amount":193.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.70,"standard_charge_algorithm":"Reimbursement will be 10.7% of billable gross charges.","estimated_amount":154.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":78.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":76.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":257.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":24.20,"standard_charge_algorithm":"Reimbursement will be 24.2% of billable gross charges.","estimated_amount":350.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.80,"standard_charge_algorithm":"Reimbursement will be 17.8% of billable gross charges.","estimated_amount":257.57,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":723.50,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":1447.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":188.11,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_percentage":115.00,"standard_charge_algorithm":"Reimbursement will be 115% of billable gross charges.","estimated_amount":1664.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":319.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":287.95,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":723.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1157.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":231.52,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":134.57,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":332.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":303.87,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":491.98,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":332.81,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":390.69,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":274.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1229.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1085.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":134.57,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":188.11,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":723.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1157.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime 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charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":412.39,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":651.15,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":366.09,"methodology":"percent of total billed charges"}]}]},{"description":"Closed treatment of calcaneal fracture; without manipulation ","code_information":[{"code":"28400","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesia ","code_information":[{"code":"26670","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"27517","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each ","code_information":[{"code":"26750","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case 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","code_information":[{"code":"27502","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of greater humeral tuberosity fracture; without manipulation ","code_information":[{"code":"23620","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health 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","code_information":[{"code":"21440","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia ","code_information":[{"code":"26700","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"CLOSED TREATMENT OF NASAL BONE FRACTURE WITHOUT MANIPULATION ","code_information":[{"code":"21310","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each 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treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation ","code_information":[{"code":"23600","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case 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","code_information":[{"code":"82948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.99,"maximum":7.56,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.80,"standard_charge_algorithm":"Reimbursement will be 9.8% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"GUIDEWIRE VASC 180CM 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"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":62413.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. 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"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":14104.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16632.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10813.90,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":13439.18,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":13838.36,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":13971.43,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":14636.73,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14237.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13306.12,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":13306.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12906.94,"methodology":"fee schedule"}]}]},{"description":"ACUTE MAJOR EYE INFECTIONS WITH CC/MCC ","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":22373.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10406.92,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":10356.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":11211.12,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":10863.81,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":10356.15,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":18028.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11507.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9585.47,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":10254.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10254.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13158.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18028.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13158.99,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":9809.59,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":10254.62,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":10153.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11168.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":15734.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":22373.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":10457.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10356.15,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":10559.21,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10356.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":10762.28,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":11371.46,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":10559.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9950.03,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9848.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10863.81,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1150.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":10762.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":10762.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12691.36,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7977.70,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":10254.62,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":10559.21,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":10660.74,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":11168.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10863.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10700.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":10153.09,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":9675.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5049.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":80.96,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":95.04,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":66.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":299.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":264.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":32.74,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":45.76,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":176.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":281.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":299.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":176.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":47.52,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":510.40,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":100.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":158.40,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":89.06,"methodology":"percent of 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(in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm ","code_information":[{"code":"14001","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"14001","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"ADMIN 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"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":6728.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7934.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4554.38,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":6410.81,"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":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":6601.23,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":6664.70,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":6982.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6791.65,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":531.38,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":65.89,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":92.11,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":354.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":566.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":602.23,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":354.25,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":95.65,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1027.33,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":201.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":318.82,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":179.25,"methodology":"percent of total billed charges"}]}]},{"description":"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC ","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1275.00,"maximum":55677.23,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10406.14,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":10355.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":11210.16,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":10862.99,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":14860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":8403.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":10355.38,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":55677.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":35540.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":29603.28,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":10253.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10253.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":40639.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":55677.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":40639.58,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":9808.74,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"MGMCR","standard_charge_dollar":10253.85,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":10152.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11167.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":15733.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":22371.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":10456.90,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10355.38,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":10558.42,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10355.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":10761.47,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":11370.61,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":10558.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9949.28,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9847.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10862.99,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":3500.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":10761.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":10761.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12690.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7977.02,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":10253.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":10558.42,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":10659.95,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":106.00,"standard_charge_algorithm":"Reimbursement will be 106% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":11167.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10862.99,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11940.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $8124 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":10152.33,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":9675.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6954.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7801 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":10152.33,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":10152.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9847.76,"methodology":"fee schedule"}]}]},{"description":"Amputation of penis; partial ","code_information":[{"code":"361","type":"RC"},{"code":"54120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9672.00,"payers_information":[{"payer_name":"AmeriHealth 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Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9672.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":8273.00,"methodology":"case rate"}]}]},{"description":"Amputation, arm through humerus; secondary closure or scar revision ","code_information":[{"code":"24925","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Amputation, arm through humerus; secondary closure or scar revision ","code_information":[{"code":"24925","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Amputation, arm through humerus; secondary closure or scar revision ","code_information":[{"code":"24925","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case rate"}]}]},{"description":"Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure ","code_information":[{"code":"26951","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth 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rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Amputation, forearm, through radius and ulna; re-amputation ","code_information":[{"code":"25909","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7054.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6033.00,"methodology":"case 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","code_information":[{"code":"481","type":"RC"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3346.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq 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","code_information":[{"code":"750","type":"RC"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3346.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq ","code_information":[{"code":"790","type":"RC"},{"code":"C5275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3346.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each ","code_information":[{"code":"750","type":"RC"},{"code":"C5274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each 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","code_information":[{"code":"499","type":"RC"},{"code":"C5271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3346.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of multi-layer compression system; leg (below knee), including ankle and foot ","code_information":[{"code":"29581","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure 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","code_information":[{"code":"20697","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3774.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case 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rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3774.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3227.00,"methodology":"case rate"}]}]},{"description":"Application of patellar tendon bearing (PTB) cast ","code_information":[{"code":"29435","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of short arm splint (forearm to hand); static ","code_information":[{"code":"29125","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; ea ","code_information":[{"code":"15278","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; ea ","code_information":[{"code":"15278","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additiona ","code_information":[{"code":"15274","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code f ","code_information":[{"code":"15272","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code f ","code_information":[{"code":"15272","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area ","code_information":[{"code":"15271","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5238.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5238.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":4478.00,"methodology":"case rate"}]}]},{"description":"Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure) ","code_information":[{"code":"61800","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure) ","code_information":[{"code":"61800","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."}]}]},{"description":"APPLICATION OF SURFACE (TRANSCUTANEOUS) NEUROSTIMULATOR (EG, TENS UNIT) ","code_information":[{"code":"369","type":"RC"},{"code":"64550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"Application, cast; figure-of-eight ","code_information":[{"code":"29049","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application, cast; figure-of-eight ","code_information":[{"code":"29049","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application, cast; plaster Velpeau ","code_information":[{"code":"29058","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application, cast; shoulder spica ","code_information":[{"code":"29055","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application, cast; shoulder spica ","code_information":[{"code":"29055","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application, cast; shoulder spica ","code_information":[{"code":"29055","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1971.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1909.00,"methodology":"case rate"}]}]},{"description":"Application, cast; shoulder to hand (long arm) ","code_information":[{"code":"29065","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2867.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be 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for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13651.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11565.00,"methodology":"case rate"}]}]},{"description":"Arthrodesis, glenohumeral joint; ","code_information":[{"code":"23800","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13651.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health 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