{"hospital_name":"HCA FLORIDA KENDALL 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 KENDALL HOSPITAL","HCA FL TOWN AND COUNTRY ER","HCA FL CUTLER BAY ER","HCA FL DORAL ER"],"hospital_address":["11750 BIRD RD, MIAMI, FL, 33175","11800 SHERRI LN, MIAMI, FL, 33183","19605 S DIXIE HWY, CUTLER BAY, FL, 33157","10915 NW 41ST ST, DORAL, FL, 33178"],"license_information":{"hospital_license_number":"4344","state":"FL"},"standard_charge_information":[{"description":"Strabismus surgery, recession or resection procedure; 2 horizontal muscles ","code_information":[{"code":"361","type":"RC"},{"code":"67312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Strabismus surgery, recession or resection procedure; 2 horizontal muscles ","code_information":[{"code":"481","type":"RC"},{"code":"67312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Strabismus surgery, recession or resection procedure; 2 or more vertical muscles (excluding superior oblique) ","code_information":[{"code":"67316","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Strapping; ankle and/or foot ","code_information":[{"code":"29540","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Strapping; elbow or wrist ","code_information":[{"code":"29260","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Strapping; elbow or wrist ","code_information":[{"code":"29260","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Strapping; elbow or wrist ","code_information":[{"code":"29260","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Strapping; knee ","code_information":[{"code":"29530","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Strapping; shoulder (eg, Velpeau) ","code_information":[{"code":"29240","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Strapping; shoulder (eg, Velpeau) ","code_information":[{"code":"29240","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Strapping; thorax ","code_information":[{"code":"29200","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Strapping; toes ","code_information":[{"code":"29550","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Strapping; Unna boot ","code_information":[{"code":"29580","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Strapping; Unna boot ","code_information":[{"code":"29580","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"STRUT EX FIX 138-201MM ","code_information":[{"code":"871433","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":12263.00,"discounted_cash":12263.00,"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":2023.39,"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":919.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2342.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":1630.98,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2207.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3065.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":3311.01,"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":3311.01,"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":3311.01,"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":3311.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":2697.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1471.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6131.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":3311.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":3311.01,"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":3311.01,"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":2967.65,"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":1643.24,"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":1312.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":649.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":600.89,"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":2182.81,"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":2967.65,"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":2182.81,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6131.50,"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":12263.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1716.82,"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":2710.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":2440.34,"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":6131.50,"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":9810.40,"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":1962.08,"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":1140.46,"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":2820.49,"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":2575.23,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":4169.42,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2820.49,"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":3311.01,"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":2329.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10423.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":9197.25,"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":1140.46,"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":1594.19,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6131.50,"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":9810.40,"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":10423.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6131.50,"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":1655.51,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":17781.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":3494.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5518.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":3102.54,"methodology":"percent of total billed charges"}]}]},{"description":"STRUT FSTFX EXFX 195-311 ","code_information":[{"code":"821149","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10407.00,"discounted_cash":10407.00,"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":1717.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":780.52,"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":1987.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":1384.13,"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":1873.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2601.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2809.89,"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":2809.89,"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":2809.89,"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":2809.89,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":2289.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1248.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5203.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2809.89,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2809.89,"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":2809.89,"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":2518.49,"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":1394.54,"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":1113.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":551.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":509.94,"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":1852.45,"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":2518.49,"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":1852.45,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5203.50,"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":10407.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1456.98,"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":2299.95,"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":2070.99,"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":5203.50,"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":8325.60,"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":1665.12,"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":967.85,"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":2393.61,"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":2185.47,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":3538.38,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2393.61,"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":2809.89,"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":1977.33,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8845.95,"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":7805.25,"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":967.85,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1352.91,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5203.50,"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":8325.60,"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":8845.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5203.50,"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":1404.94,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":15090.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2965.99,"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":4683.15,"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":2632.97,"methodology":"percent of total billed charges"}]}]},{"description":"STRUT TELESCOPIC LNG EXT ","code_information":[{"code":"872618","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10219.00,"discounted_cash":10219.00,"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":1686.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":766.42,"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":1951.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":1359.13,"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":1839.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2554.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2759.13,"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":2759.13,"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":2759.13,"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":2759.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":2248.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1226.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5109.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2759.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2759.13,"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":2759.13,"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":2473.00,"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":1369.35,"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":1093.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":541.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":500.73,"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":1818.98,"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":2473.00,"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":1818.98,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5109.50,"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":10219.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1430.66,"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":2258.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":2033.58,"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":5109.50,"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":8175.20,"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":1635.04,"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":950.37,"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":2350.37,"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":2145.99,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":3474.46,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2350.37,"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":2759.13,"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":1941.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8686.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":7664.25,"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":950.37,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1328.47,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5109.50,"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":8175.20,"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":8686.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5109.50,"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":1379.57,"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":14817.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2912.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4598.55,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":2585.41,"methodology":"percent of total billed charges"}]}]},{"description":"Stump elongation, upper extremity ","code_information":[{"code":"24935","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13545.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"STYLET LD 58X.014 BTP BL ","code_information":[{"code":"839227","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1149.00,"discounted_cash":1149.00,"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":189.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":86.17,"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":219.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":152.82,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":206.82,"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":287.25,"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":310.23,"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":310.23,"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":310.23,"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":310.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":252.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":137.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":574.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":310.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":310.23,"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":310.23,"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":278.06,"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":153.97,"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":122.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":60.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":56.30,"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":204.52,"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":278.06,"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":204.52,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":574.50,"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":1149.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":160.86,"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":253.93,"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":228.65,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":574.50,"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":919.20,"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":183.84,"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":106.86,"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":264.27,"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":241.29,"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":390.66,"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":264.27,"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":310.23,"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":218.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":976.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":861.75,"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":106.86,"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":149.37,"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":574.50,"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":919.20,"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":976.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":574.50,"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":155.12,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1666.05,"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":327.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":517.05,"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":290.70,"methodology":"percent of total billed charges"}]}]},{"description":"Subconjunctival injection ","code_information":[{"code":"361","type":"RC"},{"code":"68200","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Subconjunctival injection ","code_information":[{"code":"481","type":"RC"},{"code":"68200","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Subconjunctival injection ","code_information":[{"code":"490","type":"RC"},{"code":"68200","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin) ","code_information":[{"code":"11980","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin) ","code_information":[{"code":"11980","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Subcutaneous injection of filling material (eg, collagen); 1 cc or less ","code_information":[{"code":"11950","type":"CPT"},{"code":"790","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc ","code_information":[{"code":"11951","type":"CPT"},{"code":"790","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc ","code_information":[{"code":"11952","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Subcutaneous injection of filling material (eg, collagen); over 10.0 cc ","code_information":[{"code":"11954","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Subcutaneous injection of filling material (eg, collagen); over 10.0 cc ","code_information":[{"code":"11954","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Subdural implantation of strip electrodes through 1 or more burr or trephine hole(s) for long-term seizure monitoring ","code_information":[{"code":"61531","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial ","code_information":[{"code":"61000","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps ","code_information":[{"code":"481","type":"RC"},{"code":"61001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps ","code_information":[{"code":"490","type":"RC"},{"code":"61001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per session ","code_information":[{"code":"41530","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Submucous resection inferior turbinate, partial or complete, any method ","code_information":[{"code":"30140","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Subsequent placement of a drug-eluting ocular insert under one or more eyelids, including re-training, and removal of existing insert, unilateral or bilateral ","code_information":[{"code":"0445T","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Suction assisted lipectomy; head and neck ","code_information":[{"code":"15876","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Suction assisted lipectomy; lower extremity ","code_information":[{"code":"15879","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Suction assisted lipectomy; trunk ","code_information":[{"code":"15877","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Suction assisted lipectomy; trunk ","code_information":[{"code":"15877","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Suction assisted lipectomy; upper extremity ","code_information":[{"code":"15878","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheter ","code_information":[{"code":"36253","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheter ","code_information":[{"code":"36254","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"SUPPORT SCRO-LMBR MSH XL ","code_information":[{"code":"869454","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":313.00,"discounted_cash":313.00,"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":51.65,"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":23.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":59.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":41.63,"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":56.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":78.25,"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":84.51,"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":84.51,"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":84.51,"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":84.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":68.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":37.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":156.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":84.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":84.51,"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":84.51,"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":75.75,"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":41.94,"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":33.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":16.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":15.34,"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":55.71,"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":75.75,"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":55.71,"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":156.50,"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":313.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":43.82,"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":69.17,"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":62.29,"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":156.50,"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":250.40,"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":50.08,"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":29.11,"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":71.99,"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":65.73,"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":106.42,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":71.99,"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":84.51,"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":59.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":266.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":234.75,"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":29.11,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":40.69,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":156.50,"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":250.40,"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":266.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":156.50,"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":42.26,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":453.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":89.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":140.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":79.19,"methodology":"percent of total billed charges"}]}]},{"description":"SUPPORT SURGIBRA X-LGE ","code_information":[{"code":"806650","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1699.00,"discounted_cash":1699.00,"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":280.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":127.42,"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":324.51,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":225.97,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":305.82,"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":424.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":458.73,"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":458.73,"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":458.73,"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":458.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":373.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":203.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":849.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":458.73,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":458.73,"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":458.73,"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":411.16,"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":227.67,"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":181.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":90.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":83.25,"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":302.42,"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":411.16,"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":302.42,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":849.50,"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":1699.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":237.86,"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":375.48,"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":338.10,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":849.50,"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":1359.20,"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":271.84,"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":158.01,"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":390.77,"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":356.79,"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":577.66,"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":390.77,"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":458.73,"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":322.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1444.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1274.25,"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":158.01,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":220.87,"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":849.50,"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":1359.20,"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":1444.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":849.50,"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":229.37,"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":2463.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":484.21,"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":764.55,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":429.85,"methodology":"percent of total billed charges"}]}]},{"description":"SUPPORT W/STR SCRT XLRG ","code_information":[{"code":"802754","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":323.00,"discounted_cash":323.00,"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":53.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":24.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":61.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":42.96,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":58.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":80.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":87.21,"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":87.21,"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":87.21,"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":87.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":71.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":38.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":161.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":87.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":87.21,"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":87.21,"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":78.17,"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":43.28,"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":34.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":17.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":15.83,"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":57.49,"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":78.17,"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":57.49,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":161.50,"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":323.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":45.22,"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":71.38,"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":64.28,"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":161.50,"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":258.40,"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":51.68,"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":30.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":74.29,"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":67.83,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":109.82,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":74.29,"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":87.21,"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":61.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":274.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":242.25,"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":30.04,"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":41.99,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":161.50,"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":258.40,"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":274.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":161.50,"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":43.60,"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":468.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":92.06,"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":145.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":81.72,"methodology":"percent of total billed charges"}]}]},{"description":"Suprahyoid lymphadenectomy ","code_information":[{"code":"360","type":"RC"},{"code":"38700","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":6926.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Suprahyoid lymphadenectomy ","code_information":[{"code":"38700","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"SURG PATH LEVEL 3 ","code_information":[{"code":"793829","type":"CDM"},{"code":"88304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":329.00,"discounted_cash":329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":59.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":82.25,"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":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":72.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":39.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":164.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":164.50,"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":329.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":46.06,"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":164.50,"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":263.20,"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":52.64,"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":30.60,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":75.67,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":69.09,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":111.86,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":75.67,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":62.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":279.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":246.75,"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":30.60,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":42.77,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":164.50,"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":263.20,"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":279.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":164.50,"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":44.41,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":477.05,"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":93.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":148.05,"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":83.24,"methodology":"percent of total billed charges"}]}]},{"description":"SURG PATH LEVEL 4 ","code_information":[{"code":"794230","type":"CDM"},{"code":"88305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":329.00,"discounted_cash":329.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":59.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":82.25,"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":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":72.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":39.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":164.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":164.50,"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":329.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":46.06,"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":164.50,"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":263.20,"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":52.64,"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":30.60,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":75.67,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":69.09,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":111.86,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":75.67,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":88.83,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":62.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":279.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":246.75,"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":30.60,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":42.77,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":164.50,"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":263.20,"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":279.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":164.50,"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":44.41,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":477.05,"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":93.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":148.05,"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":83.24,"methodology":"percent of total billed charges"}]}]},{"description":"Surgical closure tracheostomy or fistula; without plastic repair ","code_information":[{"code":"31820","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; each ","code_information":[{"code":"15003","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":"Molina","plan_name":"HIX","standard_charge_dollar":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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; firs ","code_information":[{"code":"15002","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous ","code_information":[{"code":"46270","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach ","code_information":[{"code":"481","type":"RC"},{"code":"59120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach ","code_information":[{"code":"490","type":"RC"},{"code":"59120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents) ","code_information":[{"code":"87184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.41,"maximum":15.71,"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":7.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":8.38,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":7.45,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":7.48,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.90,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":15.71,"methodology":"fee schedule"}]}]},{"description":"SUT CARTRDGE OM-8175 ","code_information":[{"code":"830359","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SUT CHORD-X 2-0 ADJ 18MM ","code_information":[{"code":"901318","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"SUT TAPE MINI 2-0 ","code_information":[{"code":"920874","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1436.00,"discounted_cash":1436.00,"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":236.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":107.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":274.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":190.99,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":258.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":359.00,"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":387.72,"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":387.72,"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":387.72,"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":387.72,"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":315.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":172.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":718.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":387.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":387.72,"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":387.72,"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":347.51,"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":192.42,"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":153.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":76.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":70.36,"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":255.61,"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":347.51,"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":255.61,"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":718.00,"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":1436.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":201.04,"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":317.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":285.76,"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":718.00,"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":1148.80,"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":229.76,"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":133.55,"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":330.28,"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":301.56,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":488.24,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":330.28,"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":387.72,"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":272.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1220.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1077.00,"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":133.55,"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":186.68,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":718.00,"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":1148.80,"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":1220.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":718.00,"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":193.86,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2082.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":409.26,"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":646.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":363.31,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE 2-0 V-5 10X30IN ","code_information":[{"code":"927940","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2003.00,"discounted_cash":2003.00,"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":330.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":150.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":382.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":266.40,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":360.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":500.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":540.81,"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":540.81,"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":540.81,"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":540.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":440.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":240.36,"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":1001.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":540.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":540.81,"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":540.81,"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":484.73,"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":268.40,"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":214.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":106.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":98.15,"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":356.53,"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":484.73,"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":356.53,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1001.50,"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":2003.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":280.42,"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":442.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":398.60,"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":1001.50,"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":1602.40,"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":320.48,"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":186.28,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":460.69,"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":420.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":681.02,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":460.69,"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":540.81,"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":380.57,"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":1702.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1502.25,"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":186.28,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":260.39,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1001.50,"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":1602.40,"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":1702.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1001.50,"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":270.40,"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":2904.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":570.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":901.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":506.76,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE ABS 2-0 CT-1 L27 ","code_information":[{"code":"814212","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":41.00,"discounted_cash":41.00,"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":6.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":10.25,"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":11.07,"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":11.07,"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":11.07,"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":11.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":9.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":4.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.07,"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":11.07,"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":9.92,"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":5.49,"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":4.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.01,"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":7.30,"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":9.92,"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":7.30,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":41.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":5.74,"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":9.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":8.16,"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":20.50,"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":32.80,"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":6.56,"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":3.81,"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":9.43,"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":8.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":13.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":9.43,"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":11.07,"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":7.79,"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":34.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":30.75,"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":3.81,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":32.80,"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":34.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":5.54,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":59.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":11.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":18.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":10.37,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE ABS 27IN 19MM ","code_information":[{"code":"814324","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":104.00,"discounted_cash":104.00,"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":17.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":7.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":19.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":13.83,"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":18.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":26.00,"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":28.08,"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":28.08,"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":28.08,"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":28.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":22.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":12.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":52.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":28.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":28.08,"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":28.08,"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":25.17,"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":13.94,"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":11.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.10,"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":18.51,"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":25.17,"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":18.51,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":52.00,"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":104.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":14.56,"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":22.98,"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":20.70,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":52.00,"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":83.20,"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":16.64,"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":9.67,"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":23.92,"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":21.84,"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":35.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":23.92,"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":28.08,"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":19.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":88.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":78.00,"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":9.67,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":13.52,"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":52.00,"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":83.20,"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":88.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":52.00,"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":14.04,"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":150.80,"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":29.64,"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":46.80,"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":26.31,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE ABS 3-0 CT V327H ","code_information":[{"code":"869183","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":55.00,"discounted_cash":55.00,"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":9.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4.13,"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":10.51,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":7.32,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":9.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":13.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.85,"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":14.85,"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":14.85,"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":14.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":12.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":6.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.85,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.85,"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":14.85,"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":13.31,"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":7.37,"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":5.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.69,"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":9.79,"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":13.31,"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":9.79,"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":27.50,"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":55.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":7.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":12.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":10.95,"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":27.50,"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":44.00,"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":8.80,"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":5.12,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":12.65,"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":11.55,"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":18.70,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":12.65,"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":14.85,"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":10.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":46.75,"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":41.25,"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":5.12,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":7.15,"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":27.50,"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":44.00,"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":46.75,"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":27.50,"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":7.42,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":79.75,"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":15.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":24.75,"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":13.91,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE ANBCTRL +4-0 27IN ","code_information":[{"code":"869187","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1658.00,"discounted_cash":1658.00,"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":273.57,"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":124.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":316.68,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":220.51,"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":298.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":414.50,"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":447.66,"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":447.66,"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":447.66,"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":447.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":364.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":198.96,"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":829.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":447.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":447.66,"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":447.66,"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":401.24,"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":222.17,"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":177.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":87.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":81.24,"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":295.12,"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":401.24,"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":295.12,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":829.00,"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":1658.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":232.12,"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":366.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":329.94,"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":829.00,"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":1326.40,"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":265.28,"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":154.19,"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":381.34,"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":348.18,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":563.72,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":381.34,"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":447.66,"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":315.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1409.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1243.50,"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":154.19,"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":215.54,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":829.00,"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":1326.40,"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":1409.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":829.00,"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":223.83,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2404.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":472.53,"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":746.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":419.47,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK BRD 0 60IN ","code_information":[{"code":"814049","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":32.00,"discounted_cash":32.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":5.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":6.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":4.26,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":8.00,"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":8.64,"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":8.64,"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":8.64,"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":8.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":7.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.64,"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":8.64,"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":7.74,"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":4.29,"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":3.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.57,"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":5.70,"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":7.74,"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":5.70,"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":16.00,"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":32.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":4.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":6.37,"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":16.00,"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":25.60,"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":5.12,"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":2.98,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":7.36,"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":6.72,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":10.88,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7.36,"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":8.64,"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":6.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":27.20,"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":24.00,"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":2.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4.16,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.00,"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":25.60,"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":27.20,"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":16.00,"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":4.32,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":46.40,"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":9.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":14.40,"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":8.10,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK BRD 2-0 18IN ","code_information":[{"code":"814544","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":216.00,"discounted_cash":216.00,"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":35.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":16.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":41.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":28.73,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":38.88,"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":54.00,"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":58.32,"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":58.32,"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":58.32,"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":58.32,"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":47.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":25.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":108.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":58.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":58.32,"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":58.32,"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":52.27,"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":28.94,"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":23.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":10.58,"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":38.45,"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":52.27,"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":38.45,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":108.00,"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":216.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":30.24,"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":47.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":42.98,"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":108.00,"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":172.80,"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":34.56,"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":20.09,"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":49.68,"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":45.36,"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":73.44,"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":49.68,"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":58.32,"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":41.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":183.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":162.00,"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":20.09,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":28.08,"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":108.00,"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":172.80,"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":183.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":108.00,"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":29.16,"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":313.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":61.56,"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":97.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":54.65,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK BRD 2-0 30IN ","code_information":[{"code":"814315","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":33.00,"discounted_cash":33.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":5.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":6.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":4.39,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":8.25,"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":8.91,"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":8.91,"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":8.91,"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":8.91,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":7.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":3.96,"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":16.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.91,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.91,"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":8.91,"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":7.99,"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":4.42,"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":3.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.62,"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":5.87,"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":7.99,"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":5.87,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.50,"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":33.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":4.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":7.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":6.57,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.50,"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":26.40,"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":5.28,"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":3.07,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":7.59,"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":6.93,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":11.22,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7.59,"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":8.91,"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":6.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":28.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":24.75,"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":3.07,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4.29,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.50,"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":26.40,"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":28.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":4.46,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":47.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":9.40,"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":14.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":8.35,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK BRD 3-0 30IN ","code_information":[{"code":"814447","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38.00,"discounted_cash":38.00,"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":6.27,"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":2.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.05,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9.50,"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":10.26,"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":10.26,"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":10.26,"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":10.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":8.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":4.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":10.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":10.26,"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":10.26,"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":9.20,"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":5.09,"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":4.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.86,"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":6.76,"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":9.20,"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":6.76,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.00,"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":38.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":5.32,"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":8.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":7.56,"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":19.00,"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":30.40,"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":6.08,"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":3.53,"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":8.74,"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":7.98,"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":12.92,"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":8.74,"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":10.26,"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":7.22,"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":32.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":28.50,"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":3.53,"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":4.94,"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":19.00,"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":30.40,"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":32.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.00,"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":5.13,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":55.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":10.83,"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":17.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":9.61,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK BRD 3-0 30IN ","code_information":[{"code":"814674","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":51.00,"discounted_cash":51.00,"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":8.41,"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":3.83,"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":9.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":6.78,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":9.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":13.77,"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":13.77,"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":13.77,"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":13.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":11.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":6.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":25.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":13.77,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":13.77,"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":13.77,"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":12.34,"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":6.83,"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":5.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.50,"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":9.08,"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":12.34,"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":9.08,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":25.50,"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":51.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":7.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":11.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":10.15,"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":25.50,"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":40.80,"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":8.16,"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":4.74,"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":11.73,"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":10.71,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":17.34,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":11.73,"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":13.77,"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":9.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":43.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":38.25,"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":4.74,"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":6.63,"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":25.50,"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":40.80,"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":43.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":25.50,"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":6.88,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":73.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":14.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":22.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":12.90,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK BRD 4-0 18IN ","code_information":[{"code":"839838","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":65.00,"discounted_cash":65.00,"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":10.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4.88,"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":12.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":8.64,"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":11.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16.25,"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":17.55,"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":17.55,"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":17.55,"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":17.55,"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":14.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":7.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.55,"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":17.55,"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":15.73,"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":8.71,"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":6.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.19,"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":11.57,"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":15.73,"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":11.57,"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":32.50,"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":65.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":14.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":12.94,"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":32.50,"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":52.00,"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":10.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":6.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":14.95,"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":13.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":22.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14.95,"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":17.55,"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":12.35,"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":55.25,"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":48.75,"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":6.04,"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":8.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"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":52.00,"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":55.25,"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":32.50,"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":8.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":94.25,"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":18.52,"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":29.25,"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":16.45,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK BRD 6-018IN ","code_information":[{"code":"853334","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":297.00,"discounted_cash":297.00,"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":49.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":22.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":56.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":39.50,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":53.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":74.25,"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":80.19,"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":80.19,"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":80.19,"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":80.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":65.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":35.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":148.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":80.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":80.19,"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":80.19,"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":71.87,"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":39.80,"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":31.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":15.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":14.55,"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":52.87,"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":71.87,"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":52.87,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":148.50,"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":297.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":41.58,"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":65.64,"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":59.10,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":148.50,"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":237.60,"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":47.52,"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":27.62,"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":68.31,"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":62.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":100.98,"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":68.31,"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":80.19,"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":56.43,"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":252.45,"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":222.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":27.62,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":38.61,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":148.50,"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":237.60,"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":252.45,"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":148.50,"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":40.09,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":430.65,"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":84.64,"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":133.65,"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":75.14,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK MONO 0 18IN ","code_information":[{"code":"814191","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK MONO 3-0 30IN ","code_information":[{"code":"814757","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":46.00,"discounted_cash":46.00,"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":7.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":8.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":6.12,"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":8.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":11.50,"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":12.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":10.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":5.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.42,"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":11.13,"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":6.16,"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":4.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.25,"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":8.19,"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":11.13,"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":8.19,"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":23.00,"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":46.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":6.44,"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":10.17,"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":9.15,"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":23.00,"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":36.80,"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":7.36,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":4.28,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":10.58,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":9.66,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":15.64,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":10.58,"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":12.42,"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":8.74,"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":39.10,"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":34.50,"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":4.28,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.98,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.00,"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":36.80,"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":39.10,"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":23.00,"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":6.21,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":66.70,"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":13.11,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":20.70,"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":11.64,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK MONO 5-0 18IN ","code_information":[{"code":"814520","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":98.00,"discounted_cash":98.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":16.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":18.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":13.03,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":17.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":24.50,"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":26.46,"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":26.46,"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":26.46,"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":26.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":21.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":11.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":26.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":26.46,"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":26.46,"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":23.72,"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":13.13,"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":10.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":4.80,"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":17.44,"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":23.72,"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":17.44,"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":49.00,"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":98.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":13.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":21.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":19.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49.00,"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":78.40,"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":15.68,"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":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":22.54,"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":20.58,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":33.32,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":22.54,"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":26.46,"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":18.62,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":83.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":73.50,"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":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":12.74,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49.00,"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":78.40,"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":83.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49.00,"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":13.23,"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":142.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":27.93,"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":44.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":24.79,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK MONO 6-0 18IN ","code_information":[{"code":"814518","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":101.00,"discounted_cash":101.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":16.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":7.58,"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":19.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":13.43,"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":18.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":25.25,"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":27.27,"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":27.27,"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":27.27,"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":27.27,"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":22.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":12.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":27.27,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":27.27,"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":27.27,"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":24.44,"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":13.53,"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":10.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":4.95,"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":17.98,"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":24.44,"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":17.98,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.50,"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":101.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":14.14,"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":22.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":20.10,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.50,"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":80.80,"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":16.16,"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":9.39,"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":23.23,"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":21.21,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":23.23,"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":27.27,"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":19.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":85.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":75.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":9.39,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":13.13,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.50,"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":80.80,"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":85.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":13.63,"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":146.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":28.79,"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":45.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":25.55,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK MONO 6-0 18IN ","code_information":[{"code":"814807","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":100.00,"discounted_cash":100.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":16.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":7.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":19.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":13.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":18.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":25.00,"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":27.00,"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":27.00,"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":27.00,"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":27.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":22.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":12.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":27.00,"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":27.00,"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":24.20,"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":13.40,"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":10.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":4.90,"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":17.80,"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":24.20,"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":17.80,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.00,"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":100.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":14.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":22.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":19.90,"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":50.00,"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":80.00,"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":16.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":9.30,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":23.00,"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":21.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":34.00,"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":23.00,"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":27.00,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":19.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":85.00,"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":75.00,"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":9.30,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.00,"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":80.00,"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":85.00,"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":50.00,"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":13.50,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":145.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":28.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":45.00,"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":25.30,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK MONO 7-0 24IN ","code_information":[{"code":"846742","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1547.00,"discounted_cash":1547.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":255.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":116.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":295.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":205.75,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":278.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":386.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":417.69,"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":417.69,"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":417.69,"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":417.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":340.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":185.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":773.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":417.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":417.69,"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":417.69,"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":374.37,"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":207.30,"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":165.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":81.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":75.80,"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":275.37,"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":374.37,"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":275.37,"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":773.50,"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":1547.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":216.58,"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":341.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":307.85,"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":773.50,"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":1237.60,"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":247.52,"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":143.87,"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":355.81,"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":324.87,"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":525.98,"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":355.81,"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":417.69,"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":293.93,"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":1314.95,"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":1160.25,"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":143.87,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":201.11,"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":773.50,"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":1237.60,"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":1314.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":773.50,"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":208.84,"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":2243.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":440.89,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":696.15,"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":391.39,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLK MONO 9-0 5IN ","code_information":[{"code":"814817","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":450.00,"discounted_cash":450.00,"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":74.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":33.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":85.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":59.85,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":81.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":112.50,"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":121.50,"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":121.50,"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":121.50,"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":121.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":99.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":54.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":225.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":121.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":121.50,"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":121.50,"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":108.90,"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":60.30,"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":48.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":23.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":22.05,"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":80.10,"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":108.90,"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":80.10,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":225.00,"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":450.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":63.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":99.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":89.55,"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":225.00,"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":360.00,"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":72.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":41.85,"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":103.50,"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":94.50,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":153.00,"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":103.50,"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":121.50,"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":85.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":382.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":337.50,"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":41.85,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":58.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":225.00,"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":360.00,"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":382.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":225.00,"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":60.75,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":652.50,"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":128.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":202.50,"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":113.85,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLU MONO 0 18IN ","code_information":[{"code":"814584","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":420.00,"discounted_cash":420.00,"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":69.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":31.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":80.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":55.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":75.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":105.00,"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":113.40,"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":113.40,"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":113.40,"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":113.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":92.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":50.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":210.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":113.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":113.40,"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":113.40,"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":101.64,"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":56.28,"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":44.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":22.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":20.58,"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":74.76,"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":101.64,"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":74.76,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":210.00,"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":420.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":58.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":92.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":83.58,"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":210.00,"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":336.00,"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":67.20,"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":39.06,"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":96.60,"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":88.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":142.80,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":96.60,"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":113.40,"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":79.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":357.00,"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":315.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":39.06,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":54.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":210.00,"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":336.00,"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":357.00,"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":210.00,"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":56.70,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":609.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":119.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":189.00,"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":106.26,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLU MONO 1 30IN ","code_information":[{"code":"814848","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":65.00,"discounted_cash":65.00,"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":10.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4.88,"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":12.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":8.64,"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":11.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16.25,"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":17.55,"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":17.55,"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":17.55,"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":17.55,"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":14.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":7.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.55,"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":17.55,"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":15.73,"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":8.71,"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":6.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.19,"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":11.57,"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":15.73,"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":11.57,"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":32.50,"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":65.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":14.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":12.94,"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":32.50,"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":52.00,"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":10.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":6.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":14.95,"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":13.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":22.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14.95,"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":17.55,"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":12.35,"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":55.25,"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":48.75,"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":6.04,"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":8.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"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":52.00,"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":55.25,"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":32.50,"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":8.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":94.25,"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":18.52,"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":29.25,"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":16.45,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLU MONO 2-0 30IN ","code_information":[{"code":"814934","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":75.00,"discounted_cash":75.00,"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":12.38,"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":5.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":9.97,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":13.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":18.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.25,"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":20.25,"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":20.25,"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":20.25,"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":16.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":9.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.25,"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":20.25,"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":18.15,"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":10.05,"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":8.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":3.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.67,"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":13.35,"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":18.15,"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":13.35,"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":37.50,"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":75.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":10.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":16.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":14.93,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":60.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":12.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":6.97,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":17.25,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":15.75,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":25.50,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":14.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":56.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":6.97,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9.75,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":60.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":63.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":37.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":10.13,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":108.75,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":21.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":33.75,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":18.98,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLU MONO 3-0 36IN ","code_information":[{"code":"814936","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":158.00,"discounted_cash":158.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":26.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":11.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":30.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":21.01,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":28.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":39.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":42.66,"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":42.66,"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":42.66,"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":42.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":34.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":18.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":42.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":42.66,"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":42.66,"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":38.24,"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":21.17,"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":16.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":8.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":7.74,"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":28.12,"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":38.24,"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":28.12,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"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":158.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":22.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":34.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":31.44,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":126.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":25.28,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":36.34,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":33.18,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":53.72,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":36.34,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":42.66,"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":30.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":134.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":118.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":20.54,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":126.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":134.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":79.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":21.33,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":229.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":45.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":71.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":39.97,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLU MONO 4-0 18IN ","code_information":[{"code":"814885","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":134.00,"discounted_cash":134.00,"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":22.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":10.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":25.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":17.82,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":24.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":33.50,"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":36.18,"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":36.18,"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":36.18,"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":36.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":29.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":16.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":67.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":36.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":36.18,"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":36.18,"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":32.43,"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":17.96,"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":14.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":7.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":6.57,"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":23.85,"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":32.43,"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":23.85,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":67.00,"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":134.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":18.76,"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":29.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":26.67,"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":67.00,"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":107.20,"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":21.44,"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":12.46,"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":30.82,"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":28.14,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":45.56,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":30.82,"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":36.18,"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":25.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":113.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":100.50,"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":12.46,"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":17.42,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":67.00,"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":107.20,"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":113.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":67.00,"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":18.09,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":194.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":38.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":60.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":33.90,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLU MONO 5-0 18IN ","code_information":[{"code":"814923","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":148.00,"discounted_cash":148.00,"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":24.42,"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":11.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":28.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":19.68,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":26.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":37.00,"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":39.96,"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":39.96,"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":39.96,"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":39.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":32.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":17.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":74.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.96,"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":39.96,"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":35.82,"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":19.83,"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":15.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":7.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":7.25,"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":26.34,"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":35.82,"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":26.34,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":74.00,"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":148.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":20.72,"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":32.71,"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":29.45,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":74.00,"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":118.40,"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":23.68,"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":13.76,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":34.04,"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":31.08,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":50.32,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":34.04,"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":39.96,"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":28.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":125.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":111.00,"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":13.76,"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":19.24,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":74.00,"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":118.40,"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":125.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":74.00,"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":19.98,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":214.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":42.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":66.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":37.44,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLU MONO 5-0 30IN ","code_information":[{"code":"814912","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":146.00,"discounted_cash":146.00,"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":24.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":10.95,"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":27.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":19.42,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":26.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":36.50,"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":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":32.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":17.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":73.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"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":35.33,"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":19.56,"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":15.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":7.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":7.15,"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":25.99,"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":35.33,"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":25.99,"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":73.00,"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":146.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":20.44,"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":32.27,"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":29.05,"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":73.00,"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":116.80,"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":23.36,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":13.58,"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":33.58,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":30.66,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":49.64,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":33.58,"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":39.42,"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":27.74,"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":124.10,"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":109.50,"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":13.58,"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":18.98,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":73.00,"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":116.80,"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":124.10,"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":73.00,"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":19.71,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":211.70,"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":41.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":65.70,"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":36.94,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLU MONO 6-0 24IN ","code_information":[{"code":"871741","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2016.00,"discounted_cash":2016.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":332.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":151.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":385.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":268.13,"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":362.88,"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":504.00,"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":544.32,"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":544.32,"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":544.32,"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":544.32,"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":443.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":241.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1008.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":544.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":544.32,"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":544.32,"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":487.87,"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":270.14,"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":215.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":106.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":98.78,"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":358.85,"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":487.87,"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":358.85,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1008.00,"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":2016.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":282.24,"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":445.54,"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":401.18,"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":1008.00,"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":1612.80,"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":322.56,"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":187.49,"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":463.68,"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":423.36,"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":685.44,"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":463.68,"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":544.32,"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":383.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1713.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1512.00,"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":187.49,"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":262.08,"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":1008.00,"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":1612.80,"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":1713.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1008.00,"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":272.16,"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":2923.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":574.56,"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":907.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":510.05,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE BLU MONO 6-0 30IN ","code_information":[{"code":"874001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE C-1 6-0 1X30IN ","code_information":[{"code":"814908","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":268.00,"discounted_cash":268.00,"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":44.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":20.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":51.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":35.64,"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":48.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":67.00,"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":72.36,"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":72.36,"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":72.36,"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":72.36,"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":58.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":32.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":134.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":72.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":72.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":72.36,"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":64.86,"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":35.91,"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":28.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":14.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":13.13,"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":47.70,"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":64.86,"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":47.70,"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":134.00,"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":268.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":37.52,"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":59.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":53.33,"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":134.00,"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":214.40,"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":42.88,"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":24.92,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":61.64,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":56.28,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":91.12,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":61.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":72.36,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":50.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":227.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":201.00,"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":24.92,"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":34.84,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":134.00,"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":214.40,"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":227.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":134.00,"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":36.18,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":388.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":76.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":120.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":67.80,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CLR MONO 3-0 27IN ","code_information":[{"code":"814318","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":98.00,"discounted_cash":98.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":16.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":18.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":13.03,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":17.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":24.50,"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":26.46,"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":26.46,"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":26.46,"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":26.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":21.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":11.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":26.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":26.46,"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":26.46,"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":23.72,"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":13.13,"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":10.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":4.80,"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":17.44,"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":23.72,"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":17.44,"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":49.00,"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":98.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":13.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":21.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":19.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49.00,"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":78.40,"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":15.68,"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":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":22.54,"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":20.58,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":33.32,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":22.54,"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":26.46,"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":18.62,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":83.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":73.50,"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":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":12.74,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49.00,"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":78.40,"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":83.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":49.00,"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":13.23,"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":142.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":27.93,"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":44.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":24.79,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CRM #1 TP-1 GL30G ","code_information":[{"code":"839834","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":24.00,"discounted_cash":24.00,"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":3.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":4.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":3.19,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":6.00,"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":6.48,"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":6.48,"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":6.48,"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":6.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":5.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":2.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":6.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":6.48,"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":6.48,"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":5.81,"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":3.22,"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":2.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.18,"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":4.27,"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":5.81,"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":4.27,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12.00,"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":24.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":3.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":4.78,"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":12.00,"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":19.20,"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":3.84,"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":2.23,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":5.52,"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":5.04,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":8.16,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5.52,"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":6.48,"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":4.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":20.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":18.00,"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":2.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3.12,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12.00,"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":19.20,"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":20.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":3.24,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":34.80,"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":6.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":10.80,"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":6.07,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CT 0 8X18IN ","code_information":[{"code":"814465","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":359.00,"discounted_cash":359.00,"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":59.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":26.93,"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":68.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":47.75,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":64.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":89.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":96.93,"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":96.93,"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":96.93,"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":96.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":78.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":43.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":179.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":96.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":96.93,"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":96.93,"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":86.88,"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":48.11,"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":38.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":19.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":17.59,"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":63.90,"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":86.88,"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":63.90,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":179.50,"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":359.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":50.26,"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":79.34,"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":71.44,"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":179.50,"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":287.20,"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":57.44,"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":33.39,"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":82.57,"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":75.39,"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":122.06,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":82.57,"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":96.93,"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":68.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":305.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":269.25,"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":33.39,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":46.67,"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":179.50,"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":287.20,"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":305.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":179.50,"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":48.47,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":520.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":102.31,"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":161.55,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":90.83,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CT 1 1X36IN ","code_information":[{"code":"814696","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":87.00,"discounted_cash":87.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":14.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":6.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":16.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":11.57,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":15.66,"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":21.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":23.49,"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":23.49,"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":23.49,"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":23.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":19.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":10.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":43.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":23.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":23.49,"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":23.49,"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":21.05,"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":11.66,"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":9.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":4.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":4.26,"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":15.49,"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":21.05,"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":15.49,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":43.50,"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":87.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":12.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":19.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":17.31,"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":43.50,"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":69.60,"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":13.92,"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":8.09,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":20.01,"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":18.27,"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":29.58,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":20.01,"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":23.49,"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":16.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":73.95,"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":65.25,"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":8.09,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":11.31,"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":43.50,"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":69.60,"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":73.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":43.50,"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":11.74,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":126.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":24.80,"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":39.15,"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":22.01,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CT-1 0 1X27IN ","code_information":[{"code":"814278","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":65.00,"discounted_cash":65.00,"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":10.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4.88,"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":12.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":8.64,"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":11.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16.25,"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":17.55,"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":17.55,"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":17.55,"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":17.55,"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":14.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":7.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.55,"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":17.55,"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":15.73,"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":8.71,"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":6.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.19,"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":11.57,"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":15.73,"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":11.57,"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":32.50,"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":65.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":14.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":12.94,"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":32.50,"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":52.00,"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":10.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":6.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":14.95,"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":13.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":22.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14.95,"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":17.55,"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":12.35,"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":55.25,"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":48.75,"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":6.04,"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":8.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"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":52.00,"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":55.25,"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":32.50,"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":8.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":94.25,"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":18.52,"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":29.25,"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":16.45,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CT-1 0 1X27IN ","code_information":[{"code":"814586","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":76.00,"discounted_cash":76.00,"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":12.54,"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":5.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":14.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":13.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":19.00,"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":20.52,"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":20.52,"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":20.52,"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":20.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":16.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":9.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.52,"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":20.52,"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":18.39,"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":10.18,"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":8.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":4.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.72,"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":13.53,"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":18.39,"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":13.53,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38.00,"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":76.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":10.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":16.80,"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":15.12,"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":38.00,"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":60.80,"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":12.16,"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":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":17.48,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":15.96,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":25.84,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17.48,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.52,"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":14.44,"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":64.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":57.00,"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":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9.88,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38.00,"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":60.80,"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":64.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38.00,"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":10.26,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":110.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":21.66,"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":34.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":19.23,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CT-1 0 1X36IN ","code_information":[{"code":"814277","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":44.00,"discounted_cash":44.00,"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":7.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":8.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.85,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":11.00,"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":11.88,"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":11.88,"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":11.88,"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":11.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":9.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":5.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.88,"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":11.88,"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":10.65,"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":5.90,"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":4.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.16,"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":7.83,"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":10.65,"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":7.83,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.00,"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":44.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":6.16,"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":9.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":8.76,"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":22.00,"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":35.20,"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":7.04,"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":4.09,"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":10.12,"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":9.24,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":14.96,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":10.12,"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":11.88,"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":8.36,"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":37.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":33.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":4.09,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.72,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.00,"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":35.20,"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":37.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.00,"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":5.94,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":63.80,"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":12.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":19.80,"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":11.13,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CT-1 0 8X18IN ","code_information":[{"code":"814190","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":282.00,"discounted_cash":282.00,"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":46.53,"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":21.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":53.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":37.51,"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":50.76,"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":70.50,"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":76.14,"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":76.14,"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":76.14,"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":76.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":62.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":33.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":76.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":76.14,"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":76.14,"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":68.24,"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":37.79,"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":30.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":14.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":13.82,"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":50.20,"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":68.24,"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":50.20,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"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":282.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":39.48,"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":62.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":56.12,"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":141.00,"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":225.60,"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":45.12,"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":26.23,"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":64.86,"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":59.22,"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":95.88,"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":64.86,"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":76.14,"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":53.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":239.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":211.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":26.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":36.66,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"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":225.60,"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":239.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":38.07,"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":408.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":80.37,"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":126.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":71.35,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CT-1 2-0 8X18IN ","code_information":[{"code":"814956","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CT-1 3-0 1X36IN ","code_information":[{"code":"814708","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":44.00,"discounted_cash":44.00,"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":7.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":8.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.85,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":11.00,"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":11.88,"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":11.88,"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":11.88,"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":11.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":9.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":5.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.88,"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":11.88,"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":10.65,"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":5.90,"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":4.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.16,"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":7.83,"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":10.65,"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":7.83,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.00,"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":44.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":6.16,"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":9.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":8.76,"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":22.00,"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":35.20,"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":7.04,"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":4.09,"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":10.12,"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":9.24,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":14.96,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":10.12,"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":11.88,"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":8.36,"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":37.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":33.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":4.09,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.72,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.00,"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":35.20,"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":37.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.00,"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":5.94,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":63.80,"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":12.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":19.80,"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":11.13,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CT-2 0 1X27IN ","code_information":[{"code":"814266","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":65.00,"discounted_cash":65.00,"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":10.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4.88,"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":12.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":8.64,"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":11.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16.25,"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":17.55,"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":17.55,"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":17.55,"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":17.55,"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":14.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":7.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.55,"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":17.55,"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":15.73,"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":8.71,"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":6.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.19,"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":11.57,"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":15.73,"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":11.57,"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":32.50,"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":65.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":14.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":12.94,"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":32.50,"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":52.00,"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":10.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":6.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":14.95,"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":13.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":22.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14.95,"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":17.55,"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":12.35,"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":55.25,"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":48.75,"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":6.04,"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":8.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"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":52.00,"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":55.25,"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":32.50,"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":8.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":94.25,"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":18.52,"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":29.25,"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":16.45,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE CTX SZ1 1X14IN ","code_information":[{"code":"863143","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":647.00,"discounted_cash":647.00,"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":106.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":48.52,"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":123.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":86.05,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":116.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":161.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":174.69,"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":174.69,"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":174.69,"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":174.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":142.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":77.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":323.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":174.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":174.69,"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":174.69,"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":156.57,"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":86.70,"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":69.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":34.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":31.70,"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":115.17,"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":156.57,"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":115.17,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":323.50,"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":647.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":90.58,"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":142.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":128.75,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":323.50,"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":517.60,"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":103.52,"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":60.17,"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":148.81,"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":135.87,"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":219.98,"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":148.81,"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":174.69,"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":122.93,"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":549.95,"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":485.25,"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":60.17,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":84.11,"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":323.50,"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":517.60,"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":549.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":323.50,"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":87.34,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":938.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":184.40,"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":291.15,"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":163.69,"methodology":"percent of total billed charges"}]}]},{"description":"Suture facial nerve, intratemporal, with or without graft or decompression; including medial to geniculate ganglion ","code_information":[{"code":"361","type":"RC"},{"code":"69745","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Suture facial nerve, intratemporal, with or without graft or decompression; including medial to geniculate ganglion ","code_information":[{"code":"481","type":"RC"},{"code":"69745","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"SUTURE FBRLNK SZ 2 26IN ","code_information":[{"code":"806073","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1974.00,"discounted_cash":1974.00,"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":325.71,"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":148.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":377.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":262.54,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":355.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":493.50,"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":532.98,"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":532.98,"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":532.98,"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":532.98,"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":434.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":236.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":987.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":532.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":532.98,"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":532.98,"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":477.71,"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":264.52,"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":211.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":104.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":96.73,"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":351.37,"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":477.71,"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":351.37,"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":987.00,"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":1974.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":276.36,"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":436.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":392.83,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":987.00,"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":1579.20,"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":315.84,"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":183.58,"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":454.02,"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":414.54,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":671.16,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":454.02,"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":532.98,"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":375.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1677.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1480.50,"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":183.58,"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":256.62,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":987.00,"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":1579.20,"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":1677.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":987.00,"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":266.49,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2862.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":562.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":888.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":499.42,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE FBRWR 2 TPR 38IN ","code_information":[{"code":"861105","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1545.00,"discounted_cash":1545.00,"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":254.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":115.88,"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":295.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":205.49,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":278.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":386.25,"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":417.15,"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":417.15,"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":417.15,"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":417.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":339.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":185.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":772.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":417.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":417.15,"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":417.15,"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":373.89,"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":207.03,"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":165.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":81.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":75.71,"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":275.01,"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":373.89,"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":275.01,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":772.50,"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":1545.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":216.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":341.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":307.45,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":772.50,"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":1236.00,"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":247.20,"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":143.69,"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":355.35,"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":324.45,"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":525.30,"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":355.35,"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":417.15,"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":293.55,"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":1313.25,"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":1158.75,"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":143.69,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":200.85,"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":772.50,"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":1236.00,"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":1313.25,"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":772.50,"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":208.57,"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":2240.25,"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":440.32,"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":695.25,"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":390.88,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE FBSNR #2 26IN ","code_information":[{"code":"934411","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE FIBERLOOP 60IN ","code_information":[{"code":"863709","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1795.00,"discounted_cash":1795.00,"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":296.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":134.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":342.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":238.74,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":323.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":448.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":484.65,"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":484.65,"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":484.65,"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":484.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":394.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":215.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":484.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":484.65,"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":484.65,"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":434.39,"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":240.53,"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":192.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":95.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":87.95,"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":319.51,"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":434.39,"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":319.51,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.50,"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":1795.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":251.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":396.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":357.20,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.50,"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":1436.00,"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":287.20,"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":166.94,"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":412.85,"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":376.95,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":610.30,"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":412.85,"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":484.65,"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":341.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1525.75,"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":1346.25,"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":166.94,"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":233.35,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.50,"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":1436.00,"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":1525.75,"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":897.50,"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":242.32,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2602.75,"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":511.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":807.75,"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":454.13,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE FSL 3-0 1X30IN ","code_information":[{"code":"839863","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":222.00,"discounted_cash":222.00,"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":36.63,"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":16.65,"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":42.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":29.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":39.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":55.50,"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":59.94,"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":59.94,"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":59.94,"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":59.94,"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":48.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":26.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":111.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":59.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":59.94,"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":59.94,"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":53.72,"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":29.75,"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":23.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":11.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":10.88,"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":39.52,"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":53.72,"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":39.52,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":111.00,"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":222.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":31.08,"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":49.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":44.18,"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":111.00,"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":177.60,"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":35.52,"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":20.65,"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":51.06,"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":46.62,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":75.48,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":51.06,"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":59.94,"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":42.18,"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":188.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":166.50,"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":20.65,"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":28.86,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":111.00,"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":177.60,"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":188.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":111.00,"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":29.97,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":321.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":63.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":99.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":56.17,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE GRN BRD 2-0 30IN ","code_information":[{"code":"814106","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1988.00,"discounted_cash":1988.00,"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":328.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":149.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":379.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":264.40,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":357.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":497.00,"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":536.76,"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":536.76,"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":536.76,"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":536.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":437.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":238.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":994.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":536.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":536.76,"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":536.76,"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":481.10,"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":266.39,"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":212.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":105.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":97.41,"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":353.86,"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":481.10,"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":353.86,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":994.00,"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":1988.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":278.32,"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":439.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":395.61,"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":994.00,"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":1590.40,"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":318.08,"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":184.88,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":457.24,"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":417.48,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":675.92,"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":457.24,"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":536.76,"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":377.72,"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":1689.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1491.00,"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":184.88,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":258.44,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":994.00,"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":1590.40,"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":1689.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":994.00,"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":268.38,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2882.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":566.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":894.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":502.96,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE GRN BRD 2-0 36IN ","code_information":[{"code":"814402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":110.00,"discounted_cash":110.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":18.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":8.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":21.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":14.63,"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":19.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":27.50,"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":29.70,"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":29.70,"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":29.70,"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":29.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":24.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":13.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":55.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":29.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":29.70,"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":29.70,"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":26.62,"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":14.74,"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":11.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.39,"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":19.58,"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":26.62,"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":19.58,"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":55.00,"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":110.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":15.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":24.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":21.89,"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":55.00,"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":88.00,"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":17.60,"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":10.23,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":25.30,"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":23.10,"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":37.40,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":25.30,"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":29.70,"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":20.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":93.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":82.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":10.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":14.30,"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":55.00,"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":88.00,"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":93.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":55.00,"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":14.85,"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":159.50,"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":31.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":49.50,"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":27.83,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE GRN BRD 4-0 30IN ","code_information":[{"code":"814422","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":113.00,"discounted_cash":113.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":18.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":8.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":21.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":15.03,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":20.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":28.25,"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":30.51,"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":30.51,"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":30.51,"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":30.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":24.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":13.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":30.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":30.51,"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":30.51,"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":27.35,"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":15.14,"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":12.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.54,"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":20.11,"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":27.35,"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":20.11,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.50,"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":113.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":15.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":24.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":22.49,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.50,"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":90.40,"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":18.08,"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":10.51,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":25.99,"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":23.73,"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":38.42,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":25.99,"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":30.51,"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":21.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":96.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":84.75,"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":10.51,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.50,"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":90.40,"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":96.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":56.50,"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":15.26,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":163.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":32.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":50.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":28.59,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE GUT 2-0 27IN ","code_information":[{"code":"814642","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":77.00,"discounted_cash":77.00,"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":12.71,"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":5.78,"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":14.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":10.24,"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":13.86,"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":19.25,"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":20.79,"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":20.79,"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":20.79,"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":20.79,"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":16.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":9.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.79,"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":20.79,"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":18.63,"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":10.32,"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":8.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":4.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.77,"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":13.71,"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":18.63,"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":13.71,"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":38.50,"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":77.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":10.78,"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":17.02,"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":15.32,"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":38.50,"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":61.60,"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":12.32,"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":7.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":17.71,"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":16.17,"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":26.18,"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":17.71,"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":20.79,"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":14.63,"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":65.45,"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":57.75,"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":7.16,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":10.01,"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":38.50,"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":61.60,"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":65.45,"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":38.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":10.39,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":111.65,"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":21.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":34.65,"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":19.48,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE GUT 2-0 27IN ","code_information":[{"code":"814645","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":54.00,"discounted_cash":54.00,"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":8.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":10.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":7.18,"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":9.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":13.50,"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":14.58,"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":14.58,"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":14.58,"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":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":11.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":6.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"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":13.07,"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":7.24,"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":5.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.65,"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":9.61,"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":13.07,"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":9.61,"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":27.00,"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":54.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":7.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":11.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":10.75,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"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":43.20,"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":8.64,"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":5.02,"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":12.42,"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":11.34,"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":18.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":10.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":45.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":40.50,"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":5.02,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":7.02,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"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":43.20,"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":45.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":7.29,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":78.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":15.39,"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":24.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":13.66,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE GUT 4-0 12IN ","code_information":[{"code":"834203","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7.00,"discounted_cash":7.00,"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":1.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":0.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":0.93,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1.89,"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":1.89,"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":1.89,"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":1.89,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":0.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1.89,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1.89,"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":1.89,"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":1.69,"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":0.94,"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":0.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":0.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":0.34,"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":1.25,"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":1.69,"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":1.25,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3.50,"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":7.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":0.98,"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":1.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1.39,"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":3.50,"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":5.60,"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":1.12,"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":0.65,"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":1.61,"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":1.47,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2.38,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1.61,"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":1.89,"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":1.33,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5.95,"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":5.25,"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":0.65,"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":0.91,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3.50,"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":5.60,"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":5.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":0.94,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":10.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3.15,"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":1.77,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE GUT 4-0 18IN ","code_information":[{"code":"814563","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":282.00,"discounted_cash":282.00,"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":46.53,"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":21.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":53.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":37.51,"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":50.76,"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":70.50,"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":76.14,"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":76.14,"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":76.14,"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":76.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":62.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":33.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":76.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":76.14,"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":76.14,"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":68.24,"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":37.79,"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":30.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":14.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":13.82,"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":50.20,"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":68.24,"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":50.20,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"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":282.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":39.48,"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":62.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":56.12,"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":141.00,"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":225.60,"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":45.12,"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":26.23,"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":64.86,"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":59.22,"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":95.88,"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":64.86,"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":76.14,"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":53.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":239.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":211.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":26.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":36.66,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"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":225.60,"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":239.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":38.07,"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":408.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":80.37,"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":126.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":71.35,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE GUT 5-0 18IN ","code_information":[{"code":"814484","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":164.00,"discounted_cash":164.00,"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":27.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":12.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":31.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":21.81,"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":29.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":41.00,"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":44.28,"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":44.28,"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":44.28,"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":44.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":36.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":19.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":82.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":44.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":44.28,"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":44.28,"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":39.69,"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":21.98,"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":17.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":8.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":8.04,"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":29.19,"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":39.69,"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":29.19,"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":82.00,"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":164.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":22.96,"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":36.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":32.64,"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":82.00,"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":131.20,"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":26.24,"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":15.25,"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":37.72,"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":34.44,"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":55.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":37.72,"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":44.28,"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":31.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":139.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":123.00,"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":15.25,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":21.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":82.00,"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":131.20,"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":139.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":82.00,"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":22.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":237.80,"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":46.74,"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":73.80,"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":41.49,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE LARIAT SDPSS 30D ","code_information":[{"code":"853143","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":490.00,"discounted_cash":490.00,"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":80.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":36.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":93.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":65.17,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":88.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":122.50,"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":132.30,"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":132.30,"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":132.30,"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":132.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":107.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":58.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":245.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":132.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":132.30,"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":132.30,"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":118.58,"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":65.66,"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":52.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":25.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":24.01,"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":87.22,"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":118.58,"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":87.22,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":245.00,"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":490.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":68.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":108.29,"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":97.51,"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":245.00,"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":392.00,"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":78.40,"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":45.57,"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":112.70,"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":102.90,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":166.60,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":112.70,"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":132.30,"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":93.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":416.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":367.50,"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":45.57,"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":63.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":245.00,"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":392.00,"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":416.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":245.00,"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":66.15,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":710.50,"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":139.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":220.50,"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":123.97,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE LR 2 1X30IN ","code_information":[{"code":"814364","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":83.00,"discounted_cash":83.00,"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":13.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":6.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":15.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":11.04,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":14.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":20.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":22.41,"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":22.41,"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":22.41,"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":22.41,"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":18.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":9.96,"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":41.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":22.41,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":22.41,"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":22.41,"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":20.09,"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":11.12,"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":8.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":4.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":4.07,"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":14.77,"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":20.09,"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":14.77,"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":41.50,"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":83.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":11.62,"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":18.34,"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":16.52,"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":41.50,"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":66.40,"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":13.28,"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":7.72,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":19.09,"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":17.43,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":28.22,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":19.09,"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":22.41,"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":15.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":70.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":62.25,"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":7.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":10.79,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":41.50,"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":66.40,"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":70.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":41.50,"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":11.21,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":120.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":23.66,"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":37.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":21.00,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE MO-7 0 8X18D ","code_information":[{"code":"814088","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":332.00,"discounted_cash":332.00,"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":54.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":24.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":63.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":44.16,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":59.76,"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":83.00,"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":89.64,"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":89.64,"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":89.64,"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":89.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":73.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":39.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":166.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":89.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":89.64,"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":89.64,"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":80.34,"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":44.49,"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":35.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":17.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":16.27,"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":59.10,"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":80.34,"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":59.10,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":166.00,"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":332.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":46.48,"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":73.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":66.07,"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":166.00,"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":265.60,"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":53.12,"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":30.88,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":76.36,"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":69.72,"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":112.88,"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":76.36,"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":89.64,"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":63.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":282.20,"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":249.00,"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":30.88,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":43.16,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":166.00,"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":265.60,"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":282.20,"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":166.00,"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":44.82,"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":481.40,"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":94.62,"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":149.40,"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":84.00,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE NO NDL 0 1X54IN ","code_information":[{"code":"814144","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":78.00,"discounted_cash":78.00,"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":12.87,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":5.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":14.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":10.37,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":14.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":19.50,"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":21.06,"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":21.06,"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":21.06,"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":21.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":17.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":9.36,"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":39.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":21.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":21.06,"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":21.06,"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":18.88,"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":10.45,"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":8.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":4.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.82,"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":13.88,"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":18.88,"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":13.88,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39.00,"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":78.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":10.92,"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":17.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":15.52,"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":39.00,"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":62.40,"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":12.48,"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":7.25,"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":17.94,"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":16.38,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":26.52,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17.94,"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":21.06,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":66.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":58.50,"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":7.25,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":10.14,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39.00,"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":62.40,"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":66.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":39.00,"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":10.53,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":113.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":22.23,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":35.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":19.73,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE NO NDL 4-0 1X36IN ","code_information":[{"code":"814228","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":73.00,"discounted_cash":73.00,"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":12.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":5.47,"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":13.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":9.71,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":13.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":18.25,"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":19.71,"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":19.71,"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":19.71,"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":19.71,"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":16.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":8.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":36.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":19.71,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":19.71,"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":19.71,"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":17.67,"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":9.78,"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":7.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":3.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.58,"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":12.99,"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":17.67,"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":12.99,"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":36.50,"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":73.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":10.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":16.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":14.53,"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":36.50,"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":58.40,"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":11.68,"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":6.79,"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":16.79,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":15.33,"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":24.82,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":16.79,"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":19.71,"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":13.87,"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":62.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":54.75,"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":6.79,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9.49,"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":36.50,"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":58.40,"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":62.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":36.50,"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":9.86,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":105.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":20.80,"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":32.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":18.47,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE NONDL 2-0 12X18IN ","code_information":[{"code":"814175","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38.00,"discounted_cash":38.00,"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":6.27,"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":2.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.05,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9.50,"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":10.26,"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":10.26,"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":10.26,"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":10.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":8.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":4.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":10.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":10.26,"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":10.26,"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":9.20,"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":5.09,"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":4.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.86,"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":6.76,"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":9.20,"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":6.76,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.00,"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":38.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":5.32,"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":8.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":7.56,"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":19.00,"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":30.40,"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":6.08,"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":3.53,"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":8.74,"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":7.98,"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":12.92,"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":8.74,"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":10.26,"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":7.22,"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":32.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":28.50,"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":3.53,"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":4.94,"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":19.00,"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":30.40,"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":32.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.00,"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":5.13,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":55.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":10.83,"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":17.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":9.61,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE NONDL 2-0 12X30IN ","code_information":[{"code":"814236","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":63.00,"discounted_cash":63.00,"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":10.39,"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":4.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":12.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":8.38,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":11.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":15.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.01,"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":17.01,"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":17.01,"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":17.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":13.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":7.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":31.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.01,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.01,"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":17.01,"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":15.25,"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":8.44,"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":6.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":3.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.09,"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":11.21,"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":15.25,"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":11.21,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":31.50,"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":63.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":8.82,"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":13.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":12.54,"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":31.50,"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":50.40,"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":10.08,"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":5.86,"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":14.49,"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":13.23,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":21.42,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14.49,"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":17.01,"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":11.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":53.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":47.25,"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":5.86,"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":8.19,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":31.50,"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":50.40,"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":53.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":31.50,"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":8.51,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":91.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":17.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":28.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":15.94,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE NYL SPRMD4-0 12IN ","code_information":[{"code":"856826","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":404.00,"discounted_cash":404.00,"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":66.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":30.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":77.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":53.73,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":72.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":101.00,"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":109.08,"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":109.08,"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":109.08,"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":109.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":88.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":48.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":202.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":109.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":109.08,"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":109.08,"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":97.77,"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":54.14,"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":43.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":21.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":19.80,"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":71.91,"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":97.77,"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":71.91,"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":202.00,"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":404.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":56.56,"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":89.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":80.40,"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":202.00,"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":323.20,"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":64.64,"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":37.57,"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":92.92,"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":84.84,"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":137.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":92.92,"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":109.08,"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":76.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":343.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":303.00,"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":37.57,"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":52.52,"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":202.00,"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":323.20,"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":343.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":202.00,"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":54.54,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":585.80,"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":115.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":181.80,"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":102.21,"methodology":"percent of total billed charges"}]}]},{"description":"Suture of 1 nerve; hand or foot, common sensory nerve ","code_information":[{"code":"360","type":"RC"},{"code":"64834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":11053.00,"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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Suture of 1 nerve; median motor thenar ","code_information":[{"code":"499","type":"RC"},{"code":"64835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":11053.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Suture of 1 nerve; ulnar motor ","code_information":[{"code":"64836","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":11053.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Suture of each additional major peripheral nerve (List separately in addition to code for primary procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"64859","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Suture of each additional major peripheral nerve (List separately in addition to code for primary procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"64859","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Suture of facial nerve; extracranial ","code_information":[{"code":"361","type":"RC"},{"code":"64864","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":11053.00,"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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Suture of facial nerve; infratemporal, with or without grafting ","code_information":[{"code":"360","type":"RC"},{"code":"64865","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":11053.00,"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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Suture of infrapatellar tendon; primary ","code_information":[{"code":"27380","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":7571.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft ","code_information":[{"code":"27381","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (eg, McCannel suture) ","code_information":[{"code":"369","type":"RC"},{"code":"66682","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (eg, McCannel suture) ","code_information":[{"code":"490","type":"RC"},{"code":"66682","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Suture of major peripheral nerve, arm or leg, except sciatic; including transposition ","code_information":[{"code":"360","type":"RC"},{"code":"64856","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":11053.00,"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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Suture of nerve; requiring extensive mobilization, or transposition of nerve (List separately in addition to code for nerve suture) ","code_information":[{"code":"360","type":"RC"},{"code":"64874","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Suture of nerve; requiring secondary or delayed suture (List separately in addition to code for primary neurorrhaphy) ","code_information":[{"code":"481","type":"RC"},{"code":"64872","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Suture of nerve; requiring secondary or delayed suture (List separately in addition to code for primary neurorrhaphy) ","code_information":[{"code":"490","type":"RC"},{"code":"64872","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Suture of quadriceps or hamstring muscle rupture; primary ","code_information":[{"code":"27385","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":7571.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft ","code_information":[{"code":"27386","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; full thickness ","code_information":[{"code":"499","type":"RC"},{"code":"67935","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; partial thickness ","code_information":[{"code":"499","type":"RC"},{"code":"67930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Suture of sciatic nerve ","code_information":[{"code":"64858","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Suture of tongue to lip for micrognathia (Douglas type procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"41510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Suture of tracheal wound or injury; cervical ","code_information":[{"code":"31800","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Suture of tracheal wound or injury; cervical ","code_information":[{"code":"31800","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Suture or repair of testicular injury ","code_information":[{"code":"499","type":"RC"},{"code":"54670","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"SUTURE P-1 6-0 1X18IN ","code_information":[{"code":"814526","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":86.00,"discounted_cash":86.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":14.19,"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":6.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":16.43,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":11.44,"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":15.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":21.50,"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":23.22,"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":23.22,"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":23.22,"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":23.22,"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":18.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":10.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":43.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":23.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":23.22,"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":23.22,"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":20.81,"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":11.52,"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":9.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":4.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":4.21,"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":15.31,"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":20.81,"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":15.31,"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":43.00,"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":86.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":12.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":19.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":17.11,"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":43.00,"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":68.80,"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":13.76,"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":8.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":19.78,"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":18.06,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":29.24,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":19.78,"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":23.22,"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":16.34,"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":73.10,"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":64.50,"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":8.00,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":11.18,"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":43.00,"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":68.80,"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":73.10,"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":43.00,"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":11.61,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":124.70,"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":24.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":38.70,"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":21.76,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE P-3 4-0 1X18IN ","code_information":[{"code":"814531","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":90.00,"discounted_cash":90.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":14.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":6.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":17.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":11.97,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":16.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":22.50,"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":24.30,"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":24.30,"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":24.30,"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":24.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":19.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":10.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":45.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":24.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":24.30,"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":24.30,"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":21.78,"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":12.06,"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":9.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":4.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":4.41,"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":16.02,"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":21.78,"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":16.02,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":45.00,"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":90.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":12.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":19.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":17.91,"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":45.00,"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":72.00,"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":14.40,"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":8.37,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":20.70,"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":18.90,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":30.60,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":20.70,"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":24.30,"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":17.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":76.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":67.50,"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":8.37,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":11.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":45.00,"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":72.00,"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":76.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":45.00,"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":12.15,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":130.50,"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":25.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":40.50,"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":22.77,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PC-1 6-0 1X18IN ","code_information":[{"code":"814613","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":121.00,"discounted_cash":121.00,"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":19.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":9.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":23.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":16.09,"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":21.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":30.25,"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":32.67,"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":32.67,"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":32.67,"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":32.67,"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":26.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":14.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":32.67,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":32.67,"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":32.67,"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":29.28,"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":16.21,"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":12.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":6.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.93,"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":21.54,"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":29.28,"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":21.54,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60.50,"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":121.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":16.94,"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":26.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":24.08,"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":60.50,"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":96.80,"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":19.36,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":11.25,"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":27.83,"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":25.41,"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":41.14,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":27.83,"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":32.67,"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":22.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":102.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":90.75,"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":11.25,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":15.73,"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":60.50,"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":96.80,"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":102.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60.50,"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":16.34,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":175.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":34.48,"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":54.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":30.61,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PC-3 5-0 1-18IN ","code_information":[{"code":"814794","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1124.00,"discounted_cash":1124.00,"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":185.46,"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":84.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":214.68,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":149.49,"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":202.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":281.00,"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":303.48,"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":303.48,"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":303.48,"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":303.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":247.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":134.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":562.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":303.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":303.48,"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":303.48,"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":272.01,"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":150.62,"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":120.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":59.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":55.08,"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":200.07,"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":272.01,"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":200.07,"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":562.00,"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":1124.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":157.36,"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":248.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":223.68,"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":562.00,"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":899.20,"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":179.84,"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":104.53,"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":258.52,"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":236.04,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":382.16,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":258.52,"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":303.48,"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":213.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":955.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":843.00,"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":104.53,"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":146.12,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":562.00,"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":899.20,"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":955.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":562.00,"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":151.74,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1629.80,"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":320.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":505.80,"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":284.37,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PC-5 4-0 1-18IN ","code_information":[{"code":"839858","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":97.00,"discounted_cash":97.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":16.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":7.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":18.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":12.90,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":17.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":24.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":26.19,"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":26.19,"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":26.19,"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":26.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":21.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":11.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":26.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":26.19,"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":26.19,"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":23.47,"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":13.00,"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":10.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":4.75,"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":17.27,"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":23.47,"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":17.27,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"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":97.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":13.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":21.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":19.30,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":77.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":15.52,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":9.02,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":22.31,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":20.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":32.98,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":22.31,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":26.19,"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":18.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":82.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":72.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":9.02,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":12.61,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":77.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":82.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":48.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":13.10,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":140.65,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":27.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":43.65,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":24.54,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PDS 3-0 Z305 ","code_information":[{"code":"814331","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":42.55,"discounted_cash":42.55,"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":7.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.19,"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":8.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.66,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.66,"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":10.64,"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":11.49,"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":11.49,"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":11.49,"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":11.49,"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":9.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":5.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":21.27,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.49,"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":11.49,"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":10.30,"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":5.70,"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":4.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.08,"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":7.57,"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":10.30,"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":7.57,"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":21.27,"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":42.55,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":5.96,"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":9.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":8.47,"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":21.27,"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":34.04,"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":6.81,"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":3.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":9.79,"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":8.94,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":14.47,"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":9.79,"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":11.49,"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":8.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":36.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":31.91,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":3.96,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.53,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":21.27,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":34.04,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":36.17,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":21.27,"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":5.74,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":61.70,"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":12.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":19.15,"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":10.77,"methodology":"percent of total billed charges"}]}]},{"description":"Suture pharynx for wound or injury ","code_information":[{"code":"369","type":"RC"},{"code":"42900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"SUTURE PLN 5-0 18IN ","code_information":[{"code":"814515","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":150.00,"discounted_cash":150.00,"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":24.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":11.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":28.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":19.95,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":37.50,"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":40.50,"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":40.50,"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":40.50,"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":40.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":33.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":18.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":40.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":40.50,"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":40.50,"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":36.30,"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":20.10,"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":16.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":7.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":7.35,"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":26.70,"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":36.30,"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":26.70,"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":75.00,"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":150.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":21.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":33.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":29.85,"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":75.00,"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":120.00,"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":24.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":13.95,"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":34.50,"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":31.50,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":51.00,"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":34.50,"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":40.50,"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":28.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":127.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":112.50,"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":13.95,"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":19.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.00,"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":120.00,"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":127.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.00,"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":20.25,"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":217.50,"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":42.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":67.50,"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":37.95,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE POLY SZ 0 18IN ","code_information":[{"code":"814139","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3821.00,"discounted_cash":3821.00,"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":630.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":286.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":729.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":508.19,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":687.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":955.25,"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":1031.67,"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":1031.67,"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":1031.67,"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":1031.67,"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":840.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":458.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1910.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1031.67,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1031.67,"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":1031.67,"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":924.68,"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":512.01,"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":408.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":202.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":187.23,"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":680.14,"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":924.68,"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":680.14,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1910.50,"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":3821.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":534.94,"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":844.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":760.38,"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":1910.50,"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":3056.80,"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":611.36,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":355.35,"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":878.83,"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":802.41,"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":1299.14,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":878.83,"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":1031.67,"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":725.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3247.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2865.75,"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":355.35,"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":496.73,"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":1910.50,"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":3056.80,"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":3247.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1910.50,"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":515.84,"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":5540.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1088.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1719.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":966.71,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PRLN 4-0SH-1 36IN ","code_information":[{"code":"897516","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1989.00,"discounted_cash":1989.00,"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":328.19,"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":149.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":379.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":264.54,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":358.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":497.25,"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":537.03,"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":537.03,"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":537.03,"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":537.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":437.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":238.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":994.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":537.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":537.03,"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":537.03,"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":481.34,"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":266.53,"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":212.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":105.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":97.46,"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":354.04,"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":481.34,"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":354.04,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":994.50,"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":1989.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":278.46,"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":439.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":395.81,"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":994.50,"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":1591.20,"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":318.24,"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":184.98,"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":457.47,"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":417.69,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":676.26,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":457.47,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":537.03,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":377.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1690.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1491.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":184.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":258.57,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":994.50,"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":1591.20,"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":1690.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":994.50,"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":268.51,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2884.05,"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":566.87,"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":895.05,"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":503.22,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PRLN 5-0 M8725 ","code_information":[{"code":"844743","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1034.00,"discounted_cash":1034.00,"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":170.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":77.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":197.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":137.52,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":186.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":258.50,"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":279.18,"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":279.18,"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":279.18,"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":279.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":227.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":124.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":517.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":279.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":279.18,"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":279.18,"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":250.23,"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":138.56,"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":110.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":54.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":50.67,"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":184.05,"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":250.23,"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":184.05,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":517.00,"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":1034.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":144.76,"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":228.51,"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":205.77,"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":517.00,"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":827.20,"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":165.44,"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":96.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":237.82,"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":217.14,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":351.56,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":237.82,"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":279.18,"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":196.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":878.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":775.50,"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":96.16,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":134.42,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":517.00,"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":827.20,"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":878.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":517.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":139.59,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1499.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":294.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":465.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":261.60,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PRLN 7-0 18IN ","code_information":[{"code":"859224","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1472.00,"discounted_cash":1472.00,"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":242.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":110.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":281.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":195.78,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":264.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":368.00,"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":397.44,"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":397.44,"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":397.44,"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":397.44,"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":323.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":176.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":736.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":397.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":397.44,"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":397.44,"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":356.22,"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":197.25,"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":157.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":78.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":72.13,"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":262.02,"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":356.22,"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":262.02,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":736.00,"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":1472.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":206.08,"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":325.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":292.93,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":736.00,"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":1177.60,"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":235.52,"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":136.90,"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":338.56,"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":309.12,"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":500.48,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":338.56,"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":397.44,"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":279.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1251.20,"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":1104.00,"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":136.90,"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":191.36,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":736.00,"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":1177.60,"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":1251.20,"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":736.00,"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":198.72,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2134.40,"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":419.52,"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":662.40,"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":372.42,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PS-1 3-0 1X18IN ","code_information":[{"code":"814877","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":126.00,"discounted_cash":126.00,"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":20.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":9.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":24.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":16.76,"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":22.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":31.50,"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":34.02,"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":34.02,"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":34.02,"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":34.02,"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":27.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":15.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":63.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":34.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":34.02,"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":34.02,"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":30.49,"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":16.88,"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":13.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":6.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":6.17,"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":22.43,"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":30.49,"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":22.43,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":63.00,"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":126.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":17.64,"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":27.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":25.07,"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":63.00,"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":100.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":20.16,"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":11.72,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":28.98,"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":26.46,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":42.84,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":28.98,"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":34.02,"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":23.94,"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":107.10,"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":94.50,"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":11.72,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":16.38,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":63.00,"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":100.80,"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":107.10,"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":63.00,"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":17.01,"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":182.70,"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":35.91,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":56.70,"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":31.88,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PS-2 4-0 1X18IN ","code_information":[{"code":"824052","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":111.00,"discounted_cash":111.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":18.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":8.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":21.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":14.76,"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":19.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":27.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":29.97,"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":29.97,"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":29.97,"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":29.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":24.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":13.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":55.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":29.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":29.97,"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":29.97,"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":26.86,"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":14.87,"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":11.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.44,"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":19.76,"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":26.86,"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":19.76,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":55.50,"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":111.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":15.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":24.53,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":22.09,"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":55.50,"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":88.80,"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":17.76,"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":10.32,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":25.53,"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":23.31,"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":37.74,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":25.53,"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":29.97,"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":21.09,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":94.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":83.25,"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":10.32,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":14.43,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":55.50,"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":88.80,"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":94.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":55.50,"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":14.98,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":160.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":31.64,"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":49.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":28.08,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PS-2 5-0 1X18IN ","code_information":[{"code":"814889","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":125.00,"discounted_cash":125.00,"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":20.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":9.38,"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":23.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":16.63,"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":22.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":31.25,"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":33.75,"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":33.75,"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":33.75,"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":33.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":27.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":15.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":62.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":33.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":33.75,"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":33.75,"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":30.25,"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":16.75,"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":13.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":6.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":6.13,"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":22.25,"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":30.25,"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":22.25,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":62.50,"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":125.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":17.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":27.63,"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":24.88,"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":62.50,"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":100.00,"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":20.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":11.63,"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":28.75,"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":26.25,"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":42.50,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":28.75,"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":33.75,"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":23.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":106.25,"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":93.75,"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":11.63,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":16.25,"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":62.50,"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":100.00,"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":106.25,"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":62.50,"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":16.88,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":181.25,"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":35.63,"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":56.25,"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":31.63,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE PS-3 6-0 1X18IN ","code_information":[{"code":"814768","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":80.00,"discounted_cash":80.00,"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":13.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":6.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":15.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":10.64,"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":14.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":20.00,"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":21.60,"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":21.60,"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":21.60,"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":21.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":17.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":9.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":40.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":21.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":21.60,"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":21.60,"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":19.36,"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":10.72,"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":8.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":4.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.92,"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":14.24,"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":19.36,"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":14.24,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":40.00,"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":80.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":11.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":17.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":15.92,"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":40.00,"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":64.00,"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":12.80,"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":7.44,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":18.40,"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":16.80,"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":27.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":18.40,"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":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 Health","plan_name":"PPO","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":"Prime Health Sherriff","plan_name":"COMM","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":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":10.80,"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":116.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":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":"SUTURE QCKDRW ANCHR 5MM ","code_information":[{"code":"853277","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2992.50,"discounted_cash":2992.50,"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":493.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":224.44,"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":571.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":398.00,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":538.65,"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":748.13,"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":807.98,"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":807.98,"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":807.98,"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":807.98,"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":658.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":359.10,"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":1496.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":807.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":807.98,"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":807.98,"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":724.18,"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":401.00,"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":320.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":158.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":146.63,"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":532.66,"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":724.18,"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":532.66,"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":1496.25,"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":2992.50,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":418.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":661.34,"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":595.51,"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":1496.25,"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":2394.00,"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":478.80,"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":278.30,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":688.27,"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":628.42,"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":1017.45,"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":688.27,"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":807.98,"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":568.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2543.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2244.38,"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":278.30,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":389.02,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1496.25,"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":2394.00,"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":2543.63,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1496.25,"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":403.99,"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":4339.13,"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":852.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1346.63,"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":757.10,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE RB-1 4-0 1X18IN ","code_information":[{"code":"814967","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":362.00,"discounted_cash":362.00,"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":59.73,"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":27.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":69.14,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":48.15,"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":65.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":90.50,"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":97.74,"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":97.74,"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":97.74,"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":97.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":79.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":43.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":181.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":97.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":97.74,"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":97.74,"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":87.60,"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":48.51,"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":38.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":19.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":17.74,"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":64.44,"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":87.60,"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":64.44,"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":181.00,"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":362.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":50.68,"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":80.00,"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":72.04,"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":181.00,"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":289.60,"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":57.92,"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":33.67,"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":83.26,"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":76.02,"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":123.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":83.26,"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":97.74,"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":68.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":307.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":271.50,"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":33.67,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":47.06,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":181.00,"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":289.60,"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":307.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":181.00,"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":48.87,"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":524.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":103.17,"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":162.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":91.59,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE SH 2-0 1X27IN ","code_information":[{"code":"814312","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":41.00,"discounted_cash":41.00,"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":6.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":10.25,"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":11.07,"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":11.07,"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":11.07,"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":11.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":9.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":4.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.07,"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":11.07,"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":9.92,"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":5.49,"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":4.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.01,"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":7.30,"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":9.92,"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":7.30,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":41.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":5.74,"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":9.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":8.16,"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":20.50,"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":32.80,"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":6.56,"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":3.81,"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":9.43,"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":8.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":13.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":9.43,"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":11.07,"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":7.79,"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":34.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":30.75,"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":3.81,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":32.80,"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":34.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":5.54,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":59.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":11.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":18.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":10.37,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE SH 3-0 1X30IN ","code_information":[{"code":"814611","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":32.00,"discounted_cash":32.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":5.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":6.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":4.26,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":8.00,"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":8.64,"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":8.64,"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":8.64,"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":8.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":7.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.64,"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":8.64,"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":7.74,"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":4.29,"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":3.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.57,"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":5.70,"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":7.74,"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":5.70,"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":16.00,"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":32.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":4.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":6.37,"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":16.00,"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":25.60,"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":5.12,"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":2.98,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":7.36,"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":6.72,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":10.88,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7.36,"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":8.64,"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":6.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":27.20,"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":24.00,"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":2.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4.16,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.00,"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":25.60,"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":27.20,"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":16.00,"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":4.32,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":46.40,"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":9.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":14.40,"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":8.10,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE SPRMD X 3-0 BB 20 ","code_information":[{"code":"869594","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":438.00,"discounted_cash":438.00,"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":72.27,"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":32.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":83.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":58.25,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":78.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":109.50,"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":118.26,"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":118.26,"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":118.26,"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":118.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":96.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":52.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":219.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":118.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":118.26,"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":118.26,"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":106.00,"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":58.69,"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":46.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":23.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":21.46,"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":77.96,"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":106.00,"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":77.96,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":219.00,"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":438.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":61.32,"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":96.80,"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":87.16,"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":219.00,"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":350.40,"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":70.08,"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":40.73,"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":100.74,"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":91.98,"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":148.92,"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":100.74,"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":118.26,"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":83.22,"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":372.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":328.50,"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":40.73,"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":56.94,"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":219.00,"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":350.40,"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":372.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":219.00,"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":59.13,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":635.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":124.83,"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":197.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":110.81,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE SS 2-0 24IN ","code_information":[{"code":"814080","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":291.00,"discounted_cash":291.00,"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":48.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":21.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":55.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":38.70,"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":52.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":72.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":78.57,"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":78.57,"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":78.57,"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":78.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":64.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":34.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":78.57,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":78.57,"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":78.57,"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":70.42,"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":38.99,"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":31.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":15.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":14.26,"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":51.80,"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":70.42,"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":51.80,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":145.50,"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":291.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":40.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":64.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":57.91,"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":145.50,"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":232.80,"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":46.56,"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":27.06,"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":66.93,"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":61.11,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":98.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":66.93,"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":78.57,"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":55.29,"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":247.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":218.25,"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":27.06,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":37.83,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":145.50,"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":232.80,"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":247.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":39.28,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":421.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":82.94,"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":130.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":73.62,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE SS 7 18IN ","code_information":[{"code":"814062","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":177.00,"discounted_cash":177.00,"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":29.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":13.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":33.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":23.54,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":31.86,"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":44.25,"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":47.79,"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":47.79,"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":47.79,"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":47.79,"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":38.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":21.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":88.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":47.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":47.79,"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":47.79,"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":42.83,"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":23.72,"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":18.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":9.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":8.67,"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":31.51,"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":42.83,"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":31.51,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":88.50,"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":177.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":24.78,"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":39.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":35.22,"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":88.50,"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":141.60,"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":28.32,"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":16.46,"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":40.71,"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":37.17,"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":60.18,"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":40.71,"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":47.79,"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":33.63,"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":150.45,"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":132.75,"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":16.46,"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":23.01,"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":88.50,"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":141.60,"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":150.45,"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":88.50,"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":23.89,"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":256.65,"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":50.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":79.65,"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":44.78,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE SUPRAMID 4-0 12IN ","code_information":[{"code":"889412","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE TAPE 1.3MM 20IN ","code_information":[{"code":"904348","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4780.00,"discounted_cash":4780.00,"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":788.70,"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":358.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":912.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":635.74,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":860.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1195.00,"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":1290.60,"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":1290.60,"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":1290.60,"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":1290.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1051.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":573.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2390.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1290.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1290.60,"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":1290.60,"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":1156.76,"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":640.52,"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":511.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":253.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":234.22,"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":850.84,"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":1156.76,"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":850.84,"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":2390.00,"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":4780.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":669.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1056.38,"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":951.22,"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":2390.00,"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":3824.00,"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":764.80,"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":444.54,"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":1099.40,"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":1003.80,"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":1625.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1099.40,"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":1290.60,"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":908.20,"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":4063.00,"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":3585.00,"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":444.54,"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":621.40,"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":2390.00,"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":3824.00,"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":4063.00,"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":2390.00,"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":645.30,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":6931.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1362.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2151.00,"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":1209.34,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE TAPE 1.3MM 20IN ","code_information":[{"code":"904349","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2513.00,"discounted_cash":2513.00,"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":414.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":188.47,"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":479.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":334.23,"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":452.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":628.25,"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":678.51,"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":678.51,"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":678.51,"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":678.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":552.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":301.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1256.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":678.51,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":678.51,"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":678.51,"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":608.15,"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":336.74,"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":268.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":133.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":123.14,"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":447.31,"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":608.15,"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":447.31,"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":1256.50,"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":2513.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":351.82,"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":555.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":500.09,"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":1256.50,"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":2010.40,"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":402.08,"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":233.71,"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":577.99,"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":527.73,"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":854.42,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":577.99,"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":678.51,"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":477.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2136.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1884.75,"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":233.71,"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":326.69,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1256.50,"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":2010.40,"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":2136.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1256.50,"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":339.25,"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":3643.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":716.21,"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":1130.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":635.79,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE TAPE 2 NDL 1.3MM ","code_information":[{"code":"940012","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1974.00,"discounted_cash":1974.00,"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":325.71,"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":148.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":377.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":262.54,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":355.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":493.50,"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":532.98,"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":532.98,"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":532.98,"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":532.98,"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":434.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":236.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":987.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":532.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":532.98,"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":532.98,"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":477.71,"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":264.52,"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":211.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":104.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":96.73,"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":351.37,"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":477.71,"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":351.37,"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":987.00,"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":1974.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":276.36,"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":436.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":392.83,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":987.00,"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":1579.20,"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":315.84,"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":183.58,"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":454.02,"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":414.54,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":671.16,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":454.02,"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":532.98,"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":375.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1677.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1480.50,"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":183.58,"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":256.62,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":987.00,"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":1579.20,"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":1677.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":987.00,"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":266.49,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2862.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":562.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":888.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":499.42,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE TIGERWIRE 20IN ","code_information":[{"code":"803696","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND BRD +4-0 27IN ","code_information":[{"code":"859270","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":48.00,"discounted_cash":48.00,"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":7.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":9.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":12.00,"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":12.96,"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":12.96,"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":12.96,"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":12.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":10.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":5.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":24.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.96,"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":12.96,"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":11.62,"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":6.43,"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":5.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.35,"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":8.54,"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":11.62,"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":8.54,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":24.00,"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":48.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":6.72,"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":10.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":9.55,"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":24.00,"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":38.40,"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":7.68,"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":4.46,"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":11.04,"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":10.08,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":16.32,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":11.04,"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":12.96,"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":9.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":40.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":36.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":4.46,"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":6.24,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":24.00,"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":38.40,"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":40.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":24.00,"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":6.48,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":69.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":13.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":21.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":12.14,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND BRD 0 54IN ","code_information":[{"code":"814227","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":54.00,"discounted_cash":54.00,"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":8.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":10.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":7.18,"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":9.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":13.50,"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":14.58,"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":14.58,"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":14.58,"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":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":11.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":6.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"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":13.07,"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":7.24,"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":5.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.65,"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":9.61,"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":13.07,"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":9.61,"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":27.00,"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":54.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":7.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":11.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":10.75,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"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":43.20,"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":8.64,"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":5.02,"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":12.42,"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":11.34,"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":18.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":10.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":45.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":40.50,"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":5.02,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":7.02,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"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":43.20,"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":45.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":7.29,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":78.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":15.39,"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":24.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":13.66,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND BRD 1 27IN ","code_information":[{"code":"814192","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":47.00,"discounted_cash":47.00,"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":7.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.52,"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":8.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":6.25,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":8.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":11.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.69,"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":12.69,"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":12.69,"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":12.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":10.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":5.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.69,"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":12.69,"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":11.37,"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":6.30,"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":5.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.30,"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":8.37,"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":11.37,"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":8.37,"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":23.50,"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":47.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":6.58,"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":10.39,"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":9.35,"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":23.50,"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":37.60,"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":7.52,"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":4.37,"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":10.81,"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":9.87,"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":15.98,"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":10.81,"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":12.69,"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":8.93,"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":39.95,"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":35.25,"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":4.37,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":6.11,"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":23.50,"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":37.60,"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":39.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.50,"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":6.34,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":68.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":13.39,"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":21.15,"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":11.89,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND BRD 2-0 27IN ","code_information":[{"code":"814707","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":120.00,"discounted_cash":120.00,"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":19.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":9.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":22.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":15.96,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":21.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":30.00,"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":32.40,"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":32.40,"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":32.40,"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":32.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":26.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":14.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":32.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":32.40,"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":32.40,"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":29.04,"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":16.08,"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":12.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":6.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.88,"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":21.36,"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":29.04,"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":21.36,"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":60.00,"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":120.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":16.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":26.52,"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":23.88,"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":60.00,"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":96.00,"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":19.20,"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":11.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":27.60,"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":25.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":40.80,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":27.60,"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":32.40,"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":22.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":102.00,"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":90.00,"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":11.16,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":15.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60.00,"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":96.00,"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":102.00,"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":60.00,"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":16.20,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":174.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":34.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":54.00,"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":30.36,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND BRD 4-0 18IN ","code_information":[{"code":"814372","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":118.00,"discounted_cash":118.00,"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":19.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":8.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":22.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":15.69,"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":21.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":29.50,"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":31.86,"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":31.86,"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":31.86,"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":31.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":25.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":14.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":31.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":31.86,"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":31.86,"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":28.56,"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":15.81,"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":12.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":6.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.78,"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":21.00,"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":28.56,"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":21.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"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":118.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":16.52,"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":26.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":23.48,"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":59.00,"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":94.40,"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":18.88,"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":10.97,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":27.14,"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":24.78,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":40.12,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":27.14,"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":31.86,"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":22.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":100.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":88.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":10.97,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":15.34,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"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":94.40,"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":100.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":15.93,"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":171.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":33.63,"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":53.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":29.85,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND BRD 4-0 18IN ","code_information":[{"code":"814392","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":137.00,"discounted_cash":137.00,"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":22.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":10.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":26.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":18.22,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":24.66,"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":34.25,"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":36.99,"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":36.99,"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":36.99,"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":36.99,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":30.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":16.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":68.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":36.99,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":36.99,"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":36.99,"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":33.15,"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":18.36,"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":14.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":7.26,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":6.71,"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":24.39,"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":33.15,"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":24.39,"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":68.50,"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":137.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":19.18,"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":30.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":27.26,"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":68.50,"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":109.60,"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":21.92,"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":12.74,"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":31.51,"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":28.77,"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":46.58,"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":31.51,"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":36.99,"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":26.03,"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":116.45,"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":102.75,"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":12.74,"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":17.81,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":68.50,"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":109.60,"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":116.45,"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":68.50,"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":18.50,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":198.65,"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":39.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":61.65,"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":34.66,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND BRD 4-0 18IN ","code_information":[{"code":"815038","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":150.00,"discounted_cash":150.00,"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":24.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":11.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":28.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":19.95,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":37.50,"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":40.50,"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":40.50,"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":40.50,"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":40.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":33.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":18.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":40.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":40.50,"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":40.50,"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":36.30,"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":20.10,"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":16.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":7.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":7.35,"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":26.70,"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":36.30,"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":26.70,"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":75.00,"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":150.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":21.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":33.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":29.85,"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":75.00,"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":120.00,"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":24.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":13.95,"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":34.50,"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":31.50,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":51.00,"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":34.50,"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":40.50,"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":28.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":127.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":112.50,"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":13.95,"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":19.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.00,"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":120.00,"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":127.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.00,"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":20.25,"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":217.50,"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":42.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":67.50,"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":37.95,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND BRD 4-0 18IN ","code_information":[{"code":"857637","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":161.00,"discounted_cash":161.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":26.57,"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":12.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":30.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":21.41,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":28.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":40.25,"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":43.47,"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":43.47,"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":43.47,"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":43.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":35.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":19.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":80.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":43.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":43.47,"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":43.47,"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":38.96,"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":21.57,"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":17.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":8.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":7.89,"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":28.66,"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":38.96,"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":28.66,"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":80.50,"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":161.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":22.54,"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":35.58,"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":32.04,"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":80.50,"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":128.80,"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":25.76,"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":14.97,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":37.03,"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":33.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":54.74,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":37.03,"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":43.47,"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":30.59,"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":136.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":120.75,"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":14.97,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":20.93,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":80.50,"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":128.80,"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":136.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":80.50,"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":21.73,"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":233.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":45.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":72.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":40.73,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND BRD 5-0 27IN ","code_information":[{"code":"814201","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":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.99,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":8.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":11.25,"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":12.15,"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":12.15,"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":12.15,"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":12.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":9.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":5.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":22.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.15,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.15,"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":12.15,"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":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":5.30,"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":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.21,"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 Options","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":"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":45.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":6.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":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":"SUTURE UND BRD 6-0 18IN ","code_information":[{"code":"814965","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":118.00,"discounted_cash":118.00,"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":19.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":8.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":22.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":15.69,"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":21.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":29.50,"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":31.86,"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":31.86,"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":31.86,"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":31.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":25.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":14.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":31.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":31.86,"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":31.86,"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":28.56,"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":15.81,"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":12.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":6.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.78,"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":21.00,"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":28.56,"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":21.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"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":118.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":16.52,"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":26.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":23.48,"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":59.00,"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":94.40,"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":18.88,"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":10.97,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":27.14,"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":24.78,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":40.12,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":27.14,"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":31.86,"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":22.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":100.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":88.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":10.97,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":15.34,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"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":94.40,"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":100.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":15.93,"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":171.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":33.63,"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":53.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":29.85,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND MONO 2-0 36IN ","code_information":[{"code":"814735","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":54.00,"discounted_cash":54.00,"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":8.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":10.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":7.18,"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":9.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":13.50,"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":14.58,"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":14.58,"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":14.58,"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":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":11.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":6.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"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":13.07,"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":7.24,"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":5.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.65,"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":9.61,"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":13.07,"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":9.61,"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":27.00,"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":54.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":7.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":11.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":10.75,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"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":43.20,"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":8.64,"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":5.02,"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":12.42,"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":11.34,"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":18.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":10.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":45.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":40.50,"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":5.02,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":7.02,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"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":43.20,"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":45.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":7.29,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":78.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":15.39,"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":24.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":13.66,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND MONO 4-0 18IN ","code_information":[{"code":"839875","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":147.00,"discounted_cash":147.00,"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":24.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":11.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":28.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":19.55,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":26.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":36.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.69,"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":39.69,"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":39.69,"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":39.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":32.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":17.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":73.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.69,"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":39.69,"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":35.57,"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":19.70,"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":15.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":7.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":7.20,"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":26.17,"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":35.57,"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":26.17,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":73.50,"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":147.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":20.58,"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":32.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":29.25,"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":73.50,"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":117.60,"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":23.52,"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":13.67,"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":33.81,"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":30.87,"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":49.98,"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":33.81,"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":39.69,"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":27.93,"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":124.95,"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":110.25,"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":13.67,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":19.11,"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":73.50,"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":117.60,"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":124.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":73.50,"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":19.84,"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":213.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":41.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":66.15,"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":37.19,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND MONO 5-0 18IN ","code_information":[{"code":"834205","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":150.00,"discounted_cash":150.00,"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":24.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":11.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":28.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":19.95,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":37.50,"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":40.50,"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":40.50,"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":40.50,"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":40.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":33.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":18.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":40.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":40.50,"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":40.50,"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":36.30,"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":20.10,"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":16.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":7.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":7.35,"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":26.70,"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":36.30,"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":26.70,"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":75.00,"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":150.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":21.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":33.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":29.85,"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":75.00,"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":120.00,"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":24.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":13.95,"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":34.50,"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":31.50,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":51.00,"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":34.50,"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":40.50,"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":28.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":127.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":112.50,"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":13.95,"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":19.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.00,"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":120.00,"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":127.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":75.00,"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":20.25,"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":217.50,"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":42.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":67.50,"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":37.95,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE UND MONO 6-0 27IN ","code_information":[{"code":"867084","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":65.00,"discounted_cash":65.00,"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":10.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4.88,"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":12.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":8.64,"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":11.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":16.25,"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":17.55,"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":17.55,"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":17.55,"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":17.55,"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":14.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":7.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":17.55,"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":17.55,"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":15.73,"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":8.71,"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":6.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.19,"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":11.57,"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":15.73,"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":11.57,"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":32.50,"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":65.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":14.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":12.94,"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":32.50,"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":52.00,"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":10.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":6.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":14.95,"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":13.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":22.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":14.95,"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":17.55,"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":12.35,"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":55.25,"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":48.75,"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":6.04,"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":8.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":32.50,"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":52.00,"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":55.25,"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":32.50,"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":8.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":94.25,"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":18.52,"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":29.25,"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":16.45,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE V-34 1 1X30IN ","code_information":[{"code":"814337","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5.00,"discounted_cash":5.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":0.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":0.38,"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":0.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":0.67,"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":0.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1.25,"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":1.35,"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":1.35,"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":1.35,"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":1.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":0.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1.35,"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":1.35,"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":1.21,"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":0.67,"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":0.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":0.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":0.24,"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":0.89,"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":1.21,"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":0.89,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.50,"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":5.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":0.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":0.99,"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":2.50,"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":4.00,"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":0.80,"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":0.47,"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":1.15,"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":1.05,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1.70,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1.15,"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":1.35,"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":0.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4.25,"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":3.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":0.47,"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":0.65,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.50,"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":4.00,"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":4.25,"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":2.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":0.68,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7.25,"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":1.43,"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":2.25,"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":1.26,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VCL PLS 2 VCP306 ","code_information":[{"code":"869181","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":50.00,"discounted_cash":50.00,"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":8.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":9.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":6.65,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":9.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":12.50,"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":13.50,"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":13.50,"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":13.50,"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":13.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":11.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":6.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":25.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":13.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":13.50,"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":13.50,"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":12.10,"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":6.70,"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":5.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.45,"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":8.90,"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":12.10,"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":8.90,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":25.00,"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":50.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":7.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":11.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":9.95,"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":25.00,"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":40.00,"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":8.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":4.65,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":11.50,"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":10.50,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":17.00,"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":11.50,"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":13.50,"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":9.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":42.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":37.50,"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":4.65,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":6.50,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":25.00,"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":40.00,"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":42.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":25.00,"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":6.75,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":72.50,"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":14.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":22.50,"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":12.65,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO BRD +2-0 27IN ","code_information":[{"code":"852108","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":59.00,"discounted_cash":59.00,"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":9.73,"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":4.42,"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":11.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":7.85,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":10.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":14.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":15.93,"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":15.93,"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":15.93,"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":15.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":7.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":29.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":15.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":15.93,"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":15.93,"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":14.28,"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":7.91,"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":6.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":3.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.89,"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":10.50,"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":14.28,"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":10.50,"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":29.50,"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":59.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":8.26,"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":13.04,"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":11.74,"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":29.50,"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":47.20,"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":9.44,"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":5.49,"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":13.57,"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":12.39,"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":20.06,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":13.57,"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":15.93,"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":11.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":50.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":44.25,"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":5.49,"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":7.67,"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":29.50,"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":47.20,"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":50.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":29.50,"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":7.96,"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":85.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":16.82,"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":26.55,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":14.93,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO BRD 0 27IN ","code_information":[{"code":"814265","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":42.00,"discounted_cash":42.00,"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":6.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":8.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.59,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":10.50,"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":11.34,"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":11.34,"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":11.34,"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":11.34,"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":9.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":5.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":21.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.34,"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":11.34,"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":10.16,"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":5.63,"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":4.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.06,"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":7.48,"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":10.16,"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":7.48,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":21.00,"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":42.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":5.88,"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":9.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":8.36,"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":21.00,"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":33.60,"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":6.72,"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":3.91,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":9.66,"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":8.82,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":14.28,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":9.66,"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":11.34,"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":7.98,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":35.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":31.50,"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":3.91,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.46,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":21.00,"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":33.60,"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":35.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":21.00,"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":5.67,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":60.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":11.97,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":18.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":10.63,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO BRD 1 18IN ","code_information":[{"code":"814464","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27.00,"discounted_cash":27.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":4.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":3.59,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.86,"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":6.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7.29,"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":7.29,"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":7.29,"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":7.29,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":5.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":3.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7.29,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7.29,"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":7.29,"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":6.53,"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":3.62,"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":2.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.32,"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":4.81,"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":6.53,"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":4.81,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.50,"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":27.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":3.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":5.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":5.37,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.50,"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":21.60,"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":4.32,"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":2.51,"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":6.21,"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":5.67,"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":9.18,"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":6.21,"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":7.29,"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":5.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":22.95,"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":20.25,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":2.51,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3.51,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.50,"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":21.60,"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":22.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13.50,"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":3.65,"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":39.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":7.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12.15,"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":6.83,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO BRD 2-0 27IN ","code_information":[{"code":"814248","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":41.00,"discounted_cash":41.00,"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":6.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":10.25,"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":11.07,"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":11.07,"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":11.07,"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":11.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":9.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":4.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.07,"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":11.07,"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":9.92,"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":5.49,"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":4.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.01,"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":7.30,"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":9.92,"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":7.30,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":41.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":5.74,"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":9.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":8.16,"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":20.50,"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":32.80,"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":6.56,"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":3.81,"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":9.43,"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":8.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":13.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":9.43,"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":11.07,"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":7.79,"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":34.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":30.75,"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":3.81,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":32.80,"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":34.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":5.54,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":59.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":11.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":18.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":10.37,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO BRD 4-0 18IN ","code_information":[{"code":"867086","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":59.00,"discounted_cash":59.00,"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":9.73,"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":4.42,"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":11.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":7.85,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":10.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":14.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":15.93,"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":15.93,"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":15.93,"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":15.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":7.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":29.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":15.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":15.93,"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":15.93,"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":14.28,"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":7.91,"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":6.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":3.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.89,"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":10.50,"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":14.28,"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":10.50,"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":29.50,"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":59.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":8.26,"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":13.04,"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":11.74,"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":29.50,"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":47.20,"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":9.44,"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":5.49,"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":13.57,"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":12.39,"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":20.06,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":13.57,"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":15.93,"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":11.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":50.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":44.25,"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":5.49,"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":7.67,"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":29.50,"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":47.20,"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":50.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":29.50,"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":7.96,"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":85.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":16.82,"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":26.55,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":14.93,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO BRD 5-0 18IN ","code_information":[{"code":"814619","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":114.00,"discounted_cash":114.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":18.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":8.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":21.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":15.16,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":20.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":28.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":30.78,"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":30.78,"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":30.78,"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":30.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":25.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":13.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":30.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":30.78,"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":30.78,"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":27.59,"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":15.28,"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":12.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":6.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.59,"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":20.29,"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":27.59,"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":20.29,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"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":114.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":15.96,"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":25.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":22.69,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":91.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":18.24,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":10.60,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":26.22,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":23.94,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":38.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":26.22,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":30.78,"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":21.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":96.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":85.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":10.60,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":91.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":96.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":57.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":15.39,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":165.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":32.49,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":51.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":28.84,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO BRD 5-0 18IN ","code_information":[{"code":"814637","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":41.00,"discounted_cash":41.00,"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":6.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":10.25,"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":11.07,"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":11.07,"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":11.07,"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":11.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":9.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":4.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":11.07,"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":11.07,"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":9.92,"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":5.49,"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":4.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.01,"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":7.30,"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":9.92,"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":7.30,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":41.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":5.74,"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":9.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":8.16,"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":20.50,"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":32.80,"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":6.56,"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":3.81,"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":9.43,"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":8.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":13.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":9.43,"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":11.07,"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":7.79,"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":34.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":30.75,"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":3.81,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":5.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":32.80,"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":34.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":20.50,"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":5.54,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":59.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":11.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":18.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":10.37,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO MONO 0 18IN ","code_information":[{"code":"834213","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":134.00,"discounted_cash":134.00,"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":22.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":10.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":25.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":17.82,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":24.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":33.50,"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":36.18,"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":36.18,"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":36.18,"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":36.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":29.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":16.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":67.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":36.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":36.18,"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":36.18,"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":32.43,"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":17.96,"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":14.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":7.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":6.57,"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":23.85,"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":32.43,"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":23.85,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":67.00,"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":134.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":18.76,"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":29.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":26.67,"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":67.00,"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":107.20,"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":21.44,"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":12.46,"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":30.82,"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":28.14,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":45.56,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":30.82,"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":36.18,"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":25.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":113.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":100.50,"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":12.46,"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":17.42,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":67.00,"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":107.20,"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":113.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":67.00,"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":18.09,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":194.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":38.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":60.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":33.90,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO MONO 1 27IN ","code_information":[{"code":"814717","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":76.00,"discounted_cash":76.00,"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":12.54,"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":5.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":14.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":13.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":19.00,"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":20.52,"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":20.52,"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":20.52,"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":20.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":16.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":9.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.52,"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":20.52,"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":18.39,"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":10.18,"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":8.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":4.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":3.72,"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":13.53,"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":18.39,"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":13.53,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38.00,"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":76.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":10.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":16.80,"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":15.12,"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":38.00,"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":60.80,"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":12.16,"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":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":17.48,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":15.96,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":25.84,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":17.48,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":20.52,"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":14.44,"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":64.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":57.00,"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":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":9.88,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38.00,"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":60.80,"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":64.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":38.00,"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":10.26,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":110.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":21.66,"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":34.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":19.23,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO MONO 3-0 27IN ","code_information":[{"code":"816737","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":56.00,"discounted_cash":56.00,"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":9.24,"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":4.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":10.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":7.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":10.08,"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":14.00,"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":15.12,"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":15.12,"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":15.12,"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":15.12,"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":12.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":6.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":28.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":15.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":15.12,"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":15.12,"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":13.55,"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":7.50,"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":5.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.74,"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":9.97,"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":13.55,"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":9.97,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":28.00,"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":56.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":7.84,"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":12.38,"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":11.14,"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":28.00,"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":44.80,"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":8.96,"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":5.21,"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":12.88,"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":11.76,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":19.04,"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":12.88,"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":15.12,"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":10.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":47.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":42.00,"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":5.21,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":7.28,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":28.00,"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":44.80,"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":47.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":28.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":7.56,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":81.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":15.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":25.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":14.17,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO MONO 6-0 30IN ","code_information":[{"code":"912873","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":448.00,"discounted_cash":448.00,"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":73.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":33.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":85.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":59.58,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":80.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":112.00,"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":120.96,"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":120.96,"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":120.96,"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":120.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":98.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":53.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":224.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":120.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":120.96,"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":120.96,"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":108.42,"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":60.03,"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":47.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":23.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":21.95,"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":79.74,"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":108.42,"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":79.74,"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":224.00,"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":448.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":62.72,"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":99.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":89.15,"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":224.00,"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":358.40,"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":71.68,"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":41.66,"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":103.04,"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":94.08,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":152.32,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":103.04,"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":120.96,"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":85.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":380.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":336.00,"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":41.66,"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":58.24,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":224.00,"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":358.40,"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":380.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":224.00,"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":60.48,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":649.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":127.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":201.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":113.34,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE VIO MONO 7-0 24IN ","code_information":[{"code":"912875","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":466.00,"discounted_cash":466.00,"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":76.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":34.95,"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":89.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":61.98,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":83.88,"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":116.50,"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":125.82,"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":125.82,"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":125.82,"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":125.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":102.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":55.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":233.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":125.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":125.82,"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":125.82,"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":112.77,"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":62.44,"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":49.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":24.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":22.83,"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":82.95,"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":112.77,"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":82.95,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":233.00,"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":466.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":65.24,"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":102.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":92.73,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":233.00,"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":372.80,"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":74.56,"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":43.34,"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":107.18,"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":97.86,"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":158.44,"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":107.18,"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":125.82,"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":88.54,"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":396.10,"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":349.50,"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":43.34,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":60.58,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":233.00,"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":372.80,"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":396.10,"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":233.00,"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":62.91,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":675.70,"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":132.81,"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":209.70,"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":117.90,"methodology":"percent of total billed charges"}]}]},{"description":"SUTURE WHT BRD 4-0 18IN ","code_information":[{"code":"814990","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":101.00,"discounted_cash":101.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":16.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":7.58,"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":19.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":13.43,"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":18.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":25.25,"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":27.27,"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":27.27,"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":27.27,"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":27.27,"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":22.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":12.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":27.27,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":27.27,"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":27.27,"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":24.44,"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":13.53,"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":10.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":4.95,"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":17.98,"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":24.44,"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":17.98,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.50,"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":101.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":14.14,"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":22.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":20.10,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.50,"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":80.80,"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":16.16,"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":9.39,"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":23.23,"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":21.21,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":23.23,"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":27.27,"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":19.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":85.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":75.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":9.39,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":13.13,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.50,"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":80.80,"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":85.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":50.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":13.63,"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":146.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":28.79,"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":45.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":25.55,"methodology":"percent of total billed charges"}]}]},{"description":"Sympathectomy, cervical ","code_information":[{"code":"499","type":"RC"},{"code":"64802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sympathectomy; digital arteries, each digit ","code_information":[{"code":"64820","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sympathectomy; superficial palmar arch ","code_information":[{"code":"499","type":"RC"},{"code":"64823","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sympathectomy; ulnar artery ","code_information":[{"code":"360","type":"RC"},{"code":"64822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Syndactylization, toes (eg, webbing or Kelikian type procedure) ","code_information":[{"code":"28280","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Syndactylization, toes (eg, webbing or Kelikian type procedure) ","code_information":[{"code":"28280","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Synovectomy, extensor tendon sheath, wrist, single compartment; ","code_information":[{"code":"25118","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction, each digit ","code_information":[{"code":"26135","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Synovectomy, proximal interphalangeal joint, including extensor reconstruction, each interphalangeal joint ","code_information":[{"code":"26140","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Synovectomy, proximal interphalangeal joint, including extensor reconstruction, each interphalangeal joint ","code_information":[{"code":"26140","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Synovectomy, tendon sheath, foot; extensor ","code_information":[{"code":"28088","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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Synovectomy, tendon sheath, foot; flexor ","code_information":[{"code":"28086","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Synovectomy; intertarsal or tarsometatarsal joint, each ","code_information":[{"code":"28070","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Synovectomy; metatarsophalangeal joint, each ","code_information":[{"code":"28072","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) ","code_information":[{"code":"86592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.23,"maximum":8.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.40,"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":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":6.40,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":8.97,"methodology":"fee schedule"}]}]},{"description":"Syphilis test, non-treponemal antibody; quantitative ","code_information":[{"code":"86593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.36,"maximum":9.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.53,"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":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":6.60,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":4.40,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":9.24,"methodology":"fee schedule"}]}]},{"description":"SYRINGE 20 ASPIRTN SYS ","code_information":[{"code":"858305","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SYS CATH DLV 5FR 80CM ","code_information":[{"code":"809703","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"SYS RELVA LUM SENTRY SNS ","code_information":[{"code":"821186","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5352.00,"discounted_cash":5352.00,"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":883.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":401.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1022.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":711.82,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":963.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1338.00,"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":1445.04,"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":1445.04,"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":1445.04,"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":1445.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1177.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":642.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2676.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1445.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1445.04,"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":1445.04,"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":1295.18,"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":717.17,"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":572.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":283.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":262.25,"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":952.66,"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":1295.18,"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":952.66,"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":2676.00,"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":5352.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":749.28,"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":1182.79,"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":1065.05,"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":2676.00,"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":4281.60,"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":856.32,"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":497.74,"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":1230.96,"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":1123.92,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1819.68,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1230.96,"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":1445.04,"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":1016.88,"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":4549.20,"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":4014.00,"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":497.74,"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":695.76,"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":2676.00,"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":4281.60,"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":4549.20,"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":2676.00,"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":722.52,"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":7760.40,"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":1525.32,"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":2408.40,"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":1354.06,"methodology":"percent of total billed charges"}]}]},{"description":"SYSTEM BNCMNT MIXER ","code_information":[{"code":"818625","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SYSTEM BNCMNT VAC MX ","code_information":[{"code":"862487","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SYSTEM RETRACTOR SCRTL ","code_information":[{"code":"864432","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2441.00,"discounted_cash":2441.00,"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":402.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":183.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":466.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":324.65,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":439.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":610.25,"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":659.07,"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":659.07,"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":659.07,"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":659.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":537.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":292.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1220.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":659.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":659.07,"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":659.07,"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":590.72,"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":327.09,"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":261.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":129.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":119.61,"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":434.50,"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":590.72,"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":434.50,"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":1220.50,"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":2441.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":341.74,"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":539.46,"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":485.76,"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":1220.50,"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":1952.80,"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":390.56,"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":227.01,"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":561.43,"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":512.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":829.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":561.43,"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":659.07,"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":463.79,"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":2074.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1830.75,"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":227.01,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":317.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1220.50,"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":1952.80,"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":2074.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1220.50,"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":329.54,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3539.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":695.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1098.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":617.57,"methodology":"percent of total billed charges"}]}]},{"description":"SYSTEM STRTC BILAT ","code_information":[{"code":"851379","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":6292.00,"discounted_cash":6292.00,"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":1038.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":471.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1201.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":836.84,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1132.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1573.00,"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":1698.84,"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":1698.84,"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":1698.84,"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":1698.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1384.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":755.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3146.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1698.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1698.84,"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":1698.84,"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":1522.66,"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":843.13,"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":673.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":333.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":308.31,"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":1119.98,"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":1522.66,"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":1119.98,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3146.00,"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":6292.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":880.88,"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":1390.53,"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":1252.11,"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":3146.00,"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":5033.60,"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":1006.72,"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":585.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1447.16,"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":1321.32,"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":2139.28,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1447.16,"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":1698.84,"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":1195.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5348.20,"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":4719.00,"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":585.16,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":817.96,"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":3146.00,"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":5033.60,"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":5348.20,"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":3146.00,"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":849.42,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":9123.40,"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":1793.22,"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":2831.40,"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":1591.88,"methodology":"percent of total billed charges"}]}]},{"description":"SYSTEM XTRN DRN CSF ","code_information":[{"code":"875693","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SYSTM DRAIN VNTRC NVNT ","code_information":[{"code":"804422","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SYSTM OPN ABSRBBL FIX ","code_information":[{"code":"898831","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"T & B CELL FC 1ST MARK ","code_information":[{"code":"155827","type":"CDM"},{"code":"88184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":619.00,"discounted_cash":619.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":111.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":154.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":167.13,"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":167.13,"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":167.13,"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":167.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":136.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":74.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":309.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":167.13,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":167.13,"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":167.13,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":309.50,"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":619.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":86.66,"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":309.50,"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":495.20,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":99.04,"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":57.57,"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":142.37,"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":129.99,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":210.46,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":142.37,"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":167.13,"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":117.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":526.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":464.25,"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":57.57,"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":80.47,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":309.50,"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":495.20,"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":526.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":309.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":83.56,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":897.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":176.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":278.55,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":156.61,"methodology":"percent of total billed charges"}]}]},{"description":"Talectomy (astragalectomy) ","code_information":[{"code":"28130","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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Talectomy (astragalectomy) ","code_information":[{"code":"28130","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"TAP 1.7MMX3/4MM DELTA SE ","code_information":[{"code":"905610","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3834.00,"discounted_cash":3834.00,"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":632.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":287.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":732.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":509.92,"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":690.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":958.50,"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":1035.18,"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":1035.18,"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":1035.18,"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":1035.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":843.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":460.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1917.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1035.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1035.18,"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":1035.18,"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":927.83,"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":513.76,"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":410.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":203.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":187.87,"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":682.45,"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":927.83,"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":682.45,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1917.00,"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":3834.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":536.76,"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":847.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":762.97,"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":1917.00,"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":3067.20,"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":613.44,"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":356.56,"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":881.82,"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":805.14,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1303.56,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":881.82,"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":1035.18,"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":728.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3258.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2875.50,"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":356.56,"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":498.42,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1917.00,"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":3067.20,"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":3258.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1917.00,"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":517.59,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5559.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1092.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1725.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":970.00,"methodology":"percent of total billed charges"}]}]},{"description":"TAP BN 4.5MM ","code_information":[{"code":"945593","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":897.00,"discounted_cash":897.00,"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":148.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":67.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":171.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":119.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":161.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":224.25,"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":242.19,"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":242.19,"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":242.19,"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":242.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":197.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":107.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":242.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":242.19,"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":242.19,"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":217.07,"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":120.20,"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":95.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":47.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":43.95,"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":159.67,"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":217.07,"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":159.67,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":897.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":125.58,"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":198.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":178.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":717.60,"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":143.52,"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":83.42,"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":206.31,"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":188.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":304.98,"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":206.31,"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":242.19,"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":170.43,"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":762.45,"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":672.75,"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":83.42,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":116.61,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":717.60,"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":762.45,"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":448.50,"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":121.09,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1300.65,"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":255.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":403.65,"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":226.94,"methodology":"percent of total billed charges"}]}]},{"description":"TAP CANNULATED 3MM ","code_information":[{"code":"896169","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":482.75,"discounted_cash":482.75,"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":79.65,"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":36.21,"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":92.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":64.21,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":86.89,"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":120.69,"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":130.34,"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":130.34,"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":130.34,"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":130.34,"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":106.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":57.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":241.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":130.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":130.34,"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":130.34,"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":116.83,"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":64.69,"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":51.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":25.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":23.65,"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":85.93,"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":116.83,"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":85.93,"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":241.38,"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":482.75,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":67.58,"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":106.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":96.07,"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":241.38,"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":386.20,"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":77.24,"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":44.90,"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":111.03,"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":101.38,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":164.13,"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":111.03,"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":130.34,"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":91.72,"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":410.34,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":362.06,"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":44.90,"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":62.76,"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":241.38,"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":386.20,"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":410.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":241.38,"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":65.17,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":699.99,"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":137.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":217.24,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":122.14,"methodology":"percent of total billed charges"}]}]},{"description":"TAP CORT S-CP 3.5X70 ","code_information":[{"code":"824483","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"TAP HEX SD 3/4SCR 1.7X96 ","code_information":[{"code":"911703","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5616.00,"discounted_cash":5616.00,"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":926.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":421.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1072.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":746.93,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1010.88,"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":1404.00,"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":1516.32,"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":1516.32,"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":1516.32,"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":1516.32,"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":1235.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":673.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2808.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1516.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1516.32,"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":1516.32,"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":1359.07,"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":752.54,"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":600.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":297.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":275.18,"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":999.65,"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":1359.07,"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":999.65,"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":2808.00,"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":5616.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":786.24,"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":1241.14,"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":1117.58,"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":2808.00,"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":4492.80,"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":898.56,"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":522.29,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1291.68,"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":1179.36,"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":1909.44,"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":1291.68,"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":1516.32,"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":1067.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4773.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4212.00,"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":522.29,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":730.08,"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":2808.00,"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":4492.80,"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":4773.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2808.00,"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":758.16,"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":8143.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1600.56,"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":2527.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1420.85,"methodology":"percent of total billed charges"}]}]},{"description":"Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm ","code_information":[{"code":"11921","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm ","code_information":[{"code":"11921","type":"CPT"},{"code":"490","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition ","code_information":[{"code":"11922","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"TAVR OPEN AXILL APPROACH ","code_information":[{"code":"792429","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":24640.00,"discounted_cash":24640.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1848.00,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4435.20,"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":6652.80,"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":6652.80,"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":6652.80,"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":6652.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12320.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":6652.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":6652.80,"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":6652.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1305.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1207.36,"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":12320.00,"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":24640.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":3449.60,"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":12320.00,"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":19712.00,"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":3942.40,"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":2291.52,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":5667.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5667.20,"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":6652.80,"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":4681.60,"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":20944.00,"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":18480.00,"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":2291.52,"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":12320.00,"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":19712.00,"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":20944.00,"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":12320.00,"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":3326.40,"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":35728.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11088.00,"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":6233.92,"methodology":"percent of total billed charges"}]}]},{"description":"TAVR OPEN ILIAC APPROACH ","code_information":[{"code":"792430","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":24640.00,"discounted_cash":24640.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1848.00,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4435.20,"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":6652.80,"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":6652.80,"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":6652.80,"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":6652.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":12320.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":6652.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":6652.80,"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":6652.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1305.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1207.36,"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":12320.00,"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":24640.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":3449.60,"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":12320.00,"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":19712.00,"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":3942.40,"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":2291.52,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":5667.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":5667.20,"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":6652.80,"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":4681.60,"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":20944.00,"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":18480.00,"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":2291.52,"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":12320.00,"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":19712.00,"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":20944.00,"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":12320.00,"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":3326.40,"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":35728.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11088.00,"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":6233.92,"methodology":"percent of total billed charges"}]}]},{"description":"TAVR TRANSAPICAL EXPOSRE ","code_information":[{"code":"792432","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":22649.00,"discounted_cash":22649.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1698.67,"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":4076.82,"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":6115.23,"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":6115.23,"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":6115.23,"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":6115.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11324.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":6115.23,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":6115.23,"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":6115.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1200.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1109.80,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11324.50,"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":22649.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":3170.86,"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":11324.50,"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":18119.20,"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":3623.84,"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":2106.36,"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":5209.27,"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":5209.27,"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":6115.23,"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":4303.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":19251.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":16986.75,"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":2106.36,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11324.50,"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":18119.20,"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":19251.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":11324.50,"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":3057.61,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":32841.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":10192.05,"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":5730.20,"methodology":"percent of total billed charges"}]}]},{"description":"TBG ANG 1200 PI20IN HFLX ","code_information":[{"code":"849179","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":154.00,"discounted_cash":154.00,"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":25.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":11.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":29.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":20.48,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":27.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":38.50,"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":41.58,"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":41.58,"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":41.58,"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":41.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":33.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":18.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":77.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":41.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":41.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":41.58,"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":37.27,"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":20.64,"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":16.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":8.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":7.55,"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":27.41,"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":37.27,"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":27.41,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":77.00,"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":154.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":21.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":34.03,"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":30.65,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":77.00,"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":123.20,"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":24.64,"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":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":35.42,"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":32.34,"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":52.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":35.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":41.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":29.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":130.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":115.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":20.02,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":77.00,"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":123.20,"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":130.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":77.00,"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":20.79,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":223.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":43.89,"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":69.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":38.96,"methodology":"percent of total billed charges"}]}]},{"description":"TBG IV CNT-FL VNT 2C6 ","code_information":[{"code":"815604","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":105.00,"discounted_cash":105.00,"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":17.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":7.88,"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":20.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":13.96,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":18.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":26.25,"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":28.35,"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":28.35,"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":28.35,"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":28.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":23.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":12.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":52.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":28.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":28.35,"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":28.35,"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":25.41,"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":14.07,"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":11.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.14,"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":18.69,"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":25.41,"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":18.69,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":52.50,"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":105.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":14.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":23.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":20.89,"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":52.50,"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":84.00,"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":16.80,"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":9.77,"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":24.15,"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":22.05,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":35.70,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":24.15,"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":28.35,"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":19.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":89.25,"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":78.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":9.77,"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":13.65,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":52.50,"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":84.00,"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":89.25,"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":52.50,"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":14.18,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":152.25,"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":29.93,"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":47.25,"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":26.57,"methodology":"percent of total billed charges"}]}]},{"description":"TC99M SULFUR CO DX 20MCI ","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"122598","type":"CDM"},{"code":"A9541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1880.00,"discounted_cash":1880.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":338.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":470.00,"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":507.60,"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":507.60,"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":507.60,"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":507.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":413.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":225.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":940.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":507.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":507.60,"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":507.60,"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":940.00,"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":1880.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":263.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":415.48,"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":374.12,"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":940.00,"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":1504.00,"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":300.80,"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":174.84,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":432.40,"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":394.80,"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":639.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":432.40,"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":507.60,"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":357.20,"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":1598.00,"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":1410.00,"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":174.84,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":244.40,"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":940.00,"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":1504.00,"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":1598.00,"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":940.00,"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":253.80,"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":2726.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":535.80,"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":846.00,"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":475.64,"methodology":"percent of total billed charges"}]}]},{"description":"TEE 2D W/WOM MODE COMP ","code_information":[{"code":"121516","type":"CDM"},{"code":"93312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":26168.00,"discounted_cash":26168.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4710.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":6542.00,"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":7065.36,"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":7065.36,"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":7065.36,"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":7065.36,"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":5756.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":3140.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13084.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7065.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7065.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7065.36,"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":13084.00,"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":26168.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":3663.52,"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":5783.13,"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":5207.43,"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":13084.00,"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":20934.40,"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":4186.88,"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":2433.62,"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":6018.64,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":5495.28,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":8897.12,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6018.64,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7065.36,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":4971.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":22242.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":19626.00,"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":2433.62,"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":3401.84,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13084.00,"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":20934.40,"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":22242.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":13084.00,"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":3532.68,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":37943.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":7457.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11775.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":6620.50,"methodology":"percent of total billed charges"}]}]},{"description":"TEE IMAGE ACQ INTER/RPT ","code_information":[{"code":"587757","type":"CDM"},{"code":"93314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":2512.00,"discounted_cash":2512.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":452.16,"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":678.24,"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":678.24,"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":678.24,"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":678.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1256.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":678.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":678.24,"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":678.24,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1256.00,"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":2512.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":351.68,"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":555.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":499.89,"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":1256.00,"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":2009.60,"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":401.92,"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":233.62,"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":577.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":577.76,"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":678.24,"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":477.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2135.20,"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":1884.00,"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":233.62,"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":326.56,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1256.00,"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":2009.60,"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":2135.20,"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":1256.00,"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":339.12,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3642.40,"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":1130.40,"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":635.54,"methodology":"percent of total billed charges"}]}]},{"description":"TEMPLATE BENDING RECON 3 ","code_information":[{"code":"851082","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1628.00,"discounted_cash":1628.00,"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":268.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":122.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":310.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":216.52,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":293.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":407.00,"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":439.56,"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":439.56,"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":439.56,"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":439.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":358.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":195.36,"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":814.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":439.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":439.56,"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":439.56,"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":393.98,"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":218.15,"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":174.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":86.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":79.77,"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":289.78,"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":393.98,"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":289.78,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":814.00,"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":1628.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":227.92,"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":359.79,"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":323.97,"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":814.00,"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":1302.40,"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":260.48,"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":151.40,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":374.44,"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":341.88,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":553.52,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":374.44,"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":439.56,"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":309.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1383.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1221.00,"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":151.40,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":211.64,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":814.00,"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":1302.40,"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":1383.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":814.00,"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":219.78,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2360.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":463.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":732.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":411.88,"methodology":"percent of total billed charges"}]}]},{"description":"Temporary transcutaneous pacing ","code_information":[{"code":"790","type":"RC"},{"code":"92953","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris) ","code_information":[{"code":"20924","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":7571.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tendon lengthening, upper arm or elbow, each tendon ","code_information":[{"code":"24305","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tendon sheath incision (eg, for trigger finger) ","code_information":[{"code":"26055","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; with tendon graft(s) (includes obtaining graft), each tendon ","code_information":[{"code":"25312","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":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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Tenodesis at wrist; extensors of fingers ","code_information":[{"code":"25301","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenodesis at wrist; flexors of fingers ","code_information":[{"code":"25300","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenodesis of long tendon of biceps ","code_information":[{"code":"23430","type":"CPT"},{"code":"499","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Tenodesis of long tendon of biceps ","code_information":[{"code":"23430","type":"CPT"},{"code":"790","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Tenodesis; of proximal interphalangeal joint, each joint ","code_information":[{"code":"26471","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, complex, extensor tendon, finger, including forearm, each tendon ","code_information":[{"code":"26449","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, extensor tendon, hand OR finger, each tendon ","code_information":[{"code":"26445","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, extensor tendon, hand OR finger, each tendon ","code_information":[{"code":"26445","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, extensor tendon, hand OR finger, each tendon ","code_information":[{"code":"26445","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, extensor, foot; multiple tendons ","code_information":[{"code":"28226","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, extensor, foot; multiple tendons ","code_information":[{"code":"28226","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, extensor, foot; single tendon ","code_information":[{"code":"28225","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"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":"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each tendon ","code_information":[{"code":"25295","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, flexor or extensor tendon, leg and/or ankle; multiple tendons (through separate incisionºs») ","code_information":[{"code":"27681","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, flexor or extensor tendon, leg and/or ankle; multiple tendons (through separate incisionºs») ","code_information":[{"code":"27681","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, flexor tendon; palm AND finger, each tendon ","code_information":[{"code":"26442","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, flexor tendon; palm AND finger, each tendon ","code_information":[{"code":"26442","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, flexor, foot; multiple tendons ","code_information":[{"code":"28222","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenolysis, flexor, foot; single tendon ","code_information":[{"code":"28220","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenoplasty, with muscle transfer, with or without free graft, elbow to shoulder, single (Seddon-Brookes type procedure) ","code_information":[{"code":"24320","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenoplasty, with muscle transfer, with or without free graft, elbow to shoulder, single (Seddon-Brookes type procedure) ","code_information":[{"code":"24320","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, abductors and/or extensor(s) of hip, open (separate procedure) ","code_information":[{"code":"27006","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, adductor of hip, open ","code_information":[{"code":"27001","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, adductor of hip, percutaneous (separate procedure) ","code_information":[{"code":"27000","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, adductor, subcutaneous, open, with obturator neurectomy ","code_information":[{"code":"27003","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":7571.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open ","code_information":[{"code":"24358","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment ","code_information":[{"code":"24359","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); percutaneous ","code_information":[{"code":"24357","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, extensor, hand or finger, open, each tendon ","code_information":[{"code":"26460","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, flexor, finger, open, each tendon ","code_information":[{"code":"26455","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, flexor, palm, open, each tendon ","code_information":[{"code":"26450","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, flexor, palm, open, each tendon ","code_information":[{"code":"26450","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, lengthening, or release, abductor hallucis muscle ","code_information":[{"code":"28240","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, lengthening, or release, abductor hallucis muscle ","code_information":[{"code":"28240","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, open, elbow to shoulder, each tendon ","code_information":[{"code":"24310","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":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, open, extensor, foot or toe, each tendon ","code_information":[{"code":"28234","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":2580.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each tendon ","code_information":[{"code":"25290","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, open, hamstring, knee to hip; single tendon ","code_information":[{"code":"27390","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, open, hamstring, knee to hip; single tendon ","code_information":[{"code":"27390","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, open, tendon flexor; toe, single tendon (separate procedure) ","code_information":[{"code":"28232","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, percutaneous, Achilles tendon (separate procedure); general anesthesia ","code_information":[{"code":"27606","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, percutaneous, Achilles tendon (separate procedure); local anesthesia ","code_information":[{"code":"27605","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, percutaneous, adductor or hamstring; multiple tendons ","code_information":[{"code":"27307","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, percutaneous, adductor or hamstring; multiple tendons ","code_information":[{"code":"27307","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, percutaneous, adductor or hamstring; multiple tendons ","code_information":[{"code":"27307","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, percutaneous, adductor or hamstring; single tendon (separate procedure) ","code_information":[{"code":"27306","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, percutaneous, toe; multiple tendons ","code_information":[{"code":"28011","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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, shoulder area; multiple tendons through same incision ","code_information":[{"code":"23406","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":9587.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Tenotomy, shoulder area; single tendon ","code_information":[{"code":"23405","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":7571.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"TENSIONER CERCLAGE DISP ","code_information":[{"code":"933292","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3431.00,"discounted_cash":3431.00,"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":566.12,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":257.32,"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":655.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":456.32,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":617.58,"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":857.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":926.37,"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":926.37,"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":926.37,"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":926.37,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":754.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":411.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1715.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":926.37,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":926.37,"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":926.37,"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":830.30,"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":459.75,"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":367.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":181.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":168.12,"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":610.72,"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":830.30,"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":610.72,"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":1715.50,"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":3431.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":480.34,"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":758.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":682.77,"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":1715.50,"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":2744.80,"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":548.96,"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":319.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":789.13,"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":720.51,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1166.54,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":789.13,"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":926.37,"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":651.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2916.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2573.25,"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":319.08,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":446.03,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1715.50,"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":2744.80,"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":2916.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1715.50,"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":463.19,"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":4974.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":977.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1543.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":868.04,"methodology":"percent of total billed charges"}]}]},{"description":"Therapeutic apheresis; for plasma pheresis ","code_information":[{"code":"36514","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Therapeutic apheresis; for platelets ","code_information":[{"code":"36513","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1956.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Therapeutic apheresis; with extracorporeal immunoadsorption, selective adsorption or selective filtration and plasma reinfusion ","code_information":[{"code":"360","type":"RC"},{"code":"36516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":11053.00,"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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Therapeutic apheresis; with extracorporeal immunoadsorption, selective adsorption or selective filtration and plasma reinfusion ","code_information":[{"code":"36516","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":11053.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"THOR ENDO NIVOL LSA ","code_information":[{"code":"158588","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":12581.00,"discounted_cash":12581.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":943.58,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2264.58,"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":3396.87,"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":3396.87,"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":3396.87,"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":3396.87,"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":6290.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":3396.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":3396.87,"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":3396.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":666.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":616.47,"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":6290.50,"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":12581.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1761.34,"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":6290.50,"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":10064.80,"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":2012.96,"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":1170.03,"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":2893.63,"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":2893.63,"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":3396.87,"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":2390.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":10693.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":9435.75,"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":1170.03,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6290.50,"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":10064.80,"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":10693.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":6290.50,"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":1698.43,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":18242.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5661.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":3182.99,"methodology":"percent of total billed charges"}]}]},{"description":"Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance ","code_information":[{"code":"32554","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Thoracoscopy, diagnostic (separate procedure); lungs, pericardial sac, mediastinal or pleural space, without biopsy ","code_information":[{"code":"32601","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":"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, left or right pulmonary artery ","code_information":[{"code":"36014","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, segmental or subsegmental pulmonary artery ","code_information":[{"code":"36015","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, inc ","code_information":[{"code":"360","type":"RC"},{"code":"36225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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 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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) ","code_information":[{"code":"36011","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, venous system; second order, or more selective, branch (eg, left adrenal vein, petrosal sinus) ","code_information":[{"code":"36012","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, venous system; second order, or more selective, branch (eg, left adrenal vein, petrosal sinus) ","code_information":[{"code":"36012","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"SELFHOME ONEONE 15M PTCQ ","code_information":[{"code":"795696","type":"CDM"},{"code":"97535","type":"CPT"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","gross_charge":564.00,"discounted_cash":564.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":101.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":141.00,"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":152.28,"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":152.28,"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":152.28,"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":152.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":124.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":67.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":152.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":152.28,"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":152.28,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":282.00,"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":564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":78.96,"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":124.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":112.24,"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":282.00,"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":451.20,"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":90.24,"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":52.45,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":129.72,"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":118.44,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":191.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":129.72,"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":152.28,"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":107.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":479.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":423.00,"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":52.45,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":73.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":282.00,"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":451.20,"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":479.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":282.00,"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":76.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":817.80,"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":160.74,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":253.80,"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":142.69,"methodology":"percent of total billed charges"}]}]},{"description":"SEMI-PVT RM W/ TELE ADJ ","code_information":[{"code":"795215","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4481.00,"discounted_cash":4481.00,"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":739.37,"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":336.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":855.87,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":595.97,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":806.58,"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":1120.25,"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":1209.87,"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":1209.87,"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":1209.87,"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":1209.87,"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":985.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":537.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2240.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1209.87,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1209.87,"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":1209.87,"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":1084.40,"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":600.45,"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":479.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":237.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":219.57,"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":797.62,"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":1084.40,"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":797.62,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2240.50,"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":4481.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":627.34,"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":990.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":891.72,"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":2240.50,"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":3584.80,"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":716.96,"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":416.73,"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":1030.63,"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":941.01,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1523.54,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1030.63,"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":1209.87,"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":851.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3808.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3360.75,"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":416.73,"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":582.53,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2240.50,"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":3584.80,"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":3808.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2240.50,"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":604.93,"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":6497.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1277.09,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2016.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1133.69,"methodology":"percent of total billed charges"}]}]},{"description":"SENSOR HEMODYNAMIC SMALL ","code_information":[{"code":"899662","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2932.00,"discounted_cash":2932.00,"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":483.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":219.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":560.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":389.96,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":527.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":733.00,"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":791.64,"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":791.64,"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":791.64,"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":791.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":645.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":351.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1466.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":791.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":791.64,"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":791.64,"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":709.54,"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":392.89,"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":313.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":155.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":143.67,"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":521.90,"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":709.54,"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":521.90,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1466.00,"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":2932.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":410.48,"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":647.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":583.47,"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":1466.00,"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":2345.60,"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":469.12,"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":272.68,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":674.36,"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":615.72,"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":996.88,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":674.36,"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":791.64,"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":557.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2492.20,"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":2199.00,"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":272.68,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":381.16,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1466.00,"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":2345.60,"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":2492.20,"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":1466.00,"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":395.82,"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":4251.40,"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":835.62,"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":1319.40,"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":741.80,"methodology":"percent of total billed charges"}]}]},{"description":"SENSORY INTEGRATN 15M OT ","code_information":[{"code":"122818","type":"CDM"},{"code":"97533","type":"CPT"}],"standard_charges":[{"modifiers":"GO","modifiers_description":"Services delivered under an outpatient occupational therapy plan of care","setting":"outpatient","gross_charge":343.00,"discounted_cash":343.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":61.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":85.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":92.61,"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":92.61,"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":92.61,"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":92.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":75.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":41.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":171.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":92.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":92.61,"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":92.61,"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":171.50,"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":343.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":48.02,"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":75.80,"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":68.26,"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":171.50,"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":274.40,"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":54.88,"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":31.90,"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":78.89,"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":72.03,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":116.62,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":78.89,"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":92.61,"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":65.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":291.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":257.25,"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":31.90,"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":44.59,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":171.50,"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":274.40,"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":291.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":171.50,"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":46.30,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":497.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":97.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":154.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":86.78,"methodology":"percent of total billed charges"}]}]},{"description":"SEPARATOR THRMB 90CM ","code_information":[{"code":"892863","type":"CDM"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":11806.00,"discounted_cash":11806.00,"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":1947.99,"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":2254.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":1570.20,"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":2125.08,"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":2951.50,"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":3187.62,"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":3187.62,"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":3187.62,"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":3187.62,"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":2597.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1416.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5903.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":3187.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":3187.62,"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":3187.62,"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":2857.05,"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":1582.00,"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":1263.24,"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":2101.47,"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":2857.05,"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":2101.47,"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":5903.00,"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":11806.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1652.84,"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":2609.13,"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":2349.39,"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":5903.00,"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":9444.80,"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":1888.96,"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":1097.96,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":2715.38,"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":2479.26,"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":4014.04,"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":2715.38,"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":3187.62,"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":2243.14,"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":10035.10,"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":8854.50,"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":1097.96,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1534.78,"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":5903.00,"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":9444.80,"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":10035.10,"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":5903.00,"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":1593.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":17118.70,"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":3364.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5312.70,"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":2986.92,"methodology":"percent of total billed charges"}]}]},{"description":"Septal or other intranasal dermatoplasty (does not include obtaining graft) ","code_information":[{"code":"30620","type":"CPT"},{"code":"499","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Septal or other intranasal dermatoplasty (does not include obtaining graft) ","code_information":[{"code":"30620","type":"CPT"},{"code":"790","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"SEPTIC ARTHRITIS WITHOUT CC/MCC ","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":418.00,"maximum":41051.73,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10890.51,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":10837.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8309.78,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":10943.64,"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":5080.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":10624.89,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":41051.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":26204.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21826.98,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":10731.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10731.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":29964.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":41051.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":29964.23,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7270.95,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":10624.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11687.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11662.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":16583.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":10412.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10837.39,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":10624.89,"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":10837.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":12112.37,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":11899.88,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":10624.89,"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":10412.39,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10412.39,"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":"Leon Health","plan_name":"MCR","standard_charge_dollar":10412.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10837.39,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"case rate"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":10624.89,"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":11262.38,"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":"NaphCare","plan_name":"Prison","standard_charge_dollar":22312.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13281.11,"methodology":"fee schedule"},{"payer_name":"Odyssey HealthCare","plan_name":"COMM","standard_charge_dollar":418.00,"methodology":"per diem"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5913.14,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":10624.89,"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":11049.89,"methodology":"fee schedule"},{"payer_name":"Seasons Hospice","plan_name":"COMM","standard_charge_dollar":850.00,"methodology":"per diem"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":20718.54,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":11156.13,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":104.00,"standard_charge_algorithm":"Reimbursement will be 104% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":11687.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10731.14,"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":10400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7822 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":10624.89,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":10125.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7822 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":10624.89,"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":10624.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10306.14,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":20718.54,"methodology":"fee schedule"}]}]},{"description":"Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft ","code_information":[{"code":"30520","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist ","code_information":[{"code":"25145","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck ","code_information":[{"code":"23174","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck ","code_information":[{"code":"24136","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), scapula ","code_information":[{"code":"23172","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus ","code_information":[{"code":"24134","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":7571.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sesamoidectomy, first toe (separate procedure) ","code_information":[{"code":"28315","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sesamoidectomy, first toe (separate procedure) ","code_information":[{"code":"28315","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sesamoidectomy, first toe (separate procedure) ","code_information":[{"code":"28315","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sesamoidectomy, thumb or finger (separate procedure) ","code_information":[{"code":"26185","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"SET FILTER LEUK REDCTION ","code_information":[{"code":"926182","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"SET INST RMR TRIALS DISP ","code_information":[{"code":"930654","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2969.00,"discounted_cash":2969.00,"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":489.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":222.68,"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":567.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":394.88,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":534.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":742.25,"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":801.63,"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":801.63,"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":801.63,"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":801.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":653.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":356.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1484.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":801.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":801.63,"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":801.63,"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":718.50,"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":397.85,"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":317.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":157.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":145.48,"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":528.48,"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":718.50,"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":528.48,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1484.50,"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":2969.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":415.66,"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":656.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":590.83,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1484.50,"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":2375.20,"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":475.04,"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":276.12,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":682.87,"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":623.49,"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":1009.46,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":682.87,"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":801.63,"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":564.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2523.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2226.75,"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":276.12,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":385.97,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1484.50,"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":2375.20,"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":2523.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1484.50,"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":400.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4305.05,"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":846.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1336.05,"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":751.16,"methodology":"percent of total billed charges"}]}]},{"description":"SET IRR HIGH FLW ","code_information":[{"code":"821038","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1493.00,"discounted_cash":1493.00,"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":246.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":111.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":285.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":198.57,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":268.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":373.25,"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":403.11,"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":403.11,"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":403.11,"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":403.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":328.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":179.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":746.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":403.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":403.11,"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":403.11,"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":361.31,"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":200.06,"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":159.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":79.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":73.16,"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":265.75,"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":361.31,"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":265.75,"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":746.50,"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":1493.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":209.02,"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":329.95,"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":297.11,"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":746.50,"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":1194.40,"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":238.88,"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":138.85,"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":343.39,"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":313.53,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":507.62,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":343.39,"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":403.11,"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":283.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1269.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1119.75,"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":138.85,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":194.09,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":746.50,"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":1194.40,"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":1269.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":746.50,"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":201.56,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2164.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":425.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":671.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":377.73,"methodology":"percent of total billed charges"}]}]},{"description":"SET IRR TBNG CORD DISP ","code_information":[{"code":"896279","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1472.00,"discounted_cash":1472.00,"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":242.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":110.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":281.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":195.78,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":264.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":368.00,"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":397.44,"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":397.44,"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":397.44,"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":397.44,"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":323.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":176.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":736.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":397.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":397.44,"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":397.44,"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":356.22,"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":197.25,"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":157.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":78.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":72.13,"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":262.02,"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":356.22,"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":262.02,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":736.00,"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":1472.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":206.08,"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":325.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":292.93,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":736.00,"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":1177.60,"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":235.52,"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":136.90,"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":338.56,"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":309.12,"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":500.48,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":338.56,"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":397.44,"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":279.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1251.20,"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":1104.00,"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":136.90,"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":191.36,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":736.00,"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":1177.60,"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":1251.20,"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":736.00,"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":198.72,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2134.40,"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":419.52,"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":662.40,"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":372.42,"methodology":"percent of total billed charges"}]}]},{"description":"SET IRR URO .28IN 81IN ","code_information":[{"code":"815562","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":256.00,"discounted_cash":256.00,"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":42.24,"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":19.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":48.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":34.05,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":46.08,"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":64.00,"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":69.12,"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":69.12,"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":69.12,"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":69.12,"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":56.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":30.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":128.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":69.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":69.12,"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":69.12,"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":61.95,"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":34.30,"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":27.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":13.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":12.54,"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":45.57,"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":61.95,"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":45.57,"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":128.00,"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":256.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":35.84,"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":56.58,"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":50.94,"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":128.00,"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":204.80,"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":40.96,"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":23.81,"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":58.88,"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":53.76,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":87.04,"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":58.88,"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":69.12,"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":48.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":217.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":192.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":23.81,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":33.28,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":128.00,"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":204.80,"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":217.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":128.00,"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":34.56,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":371.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":72.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":115.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":64.77,"methodology":"percent of total billed charges"}]}]},{"description":"SET PEG SFTY PSH 20FR ","code_information":[{"code":"838883","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":621.60,"discounted_cash":621.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":102.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":46.62,"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":118.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":82.67,"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":111.89,"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":155.40,"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":167.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":167.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":167.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":167.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":136.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":74.59,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":310.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":167.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":167.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":167.83,"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":150.43,"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":83.29,"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":66.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":32.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":30.46,"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":110.64,"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":150.43,"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":110.64,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":310.80,"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":621.60,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":87.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":137.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":123.70,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":310.80,"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":497.28,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":99.46,"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":57.81,"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":142.97,"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":130.54,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":211.34,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":142.97,"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":167.83,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":118.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":528.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":466.20,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":57.81,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":80.81,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":310.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":497.28,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":528.36,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":310.80,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":83.92,"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":901.32,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":177.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":279.72,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":157.26,"methodology":"percent of total billed charges"}]}]},{"description":"SET SHTH DIL 13FR 40.6CM ","code_information":[{"code":"863453","type":"CDM"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":14789.00,"discounted_cash":14789.00,"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":2440.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":2824.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":1966.94,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2662.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":3697.25,"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":3993.03,"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":3993.03,"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":3993.03,"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":3993.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":3253.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1774.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7394.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":3993.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":3993.03,"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":3993.03,"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":3578.94,"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":1981.73,"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":1582.42,"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":2632.44,"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":3578.94,"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":2632.44,"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":7394.50,"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":14789.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":2070.46,"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":3268.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":2943.01,"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":7394.50,"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":11831.20,"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":2366.24,"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":1375.38,"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":3401.47,"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":3105.69,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":5028.26,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3401.47,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":3993.03,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":2809.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12570.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":11091.75,"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":1375.38,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1922.57,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7394.50,"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":11831.20,"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":12570.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":7394.50,"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":1996.52,"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":21444.05,"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":4214.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6655.05,"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":3741.62,"methodology":"percent of total billed charges"}]}]},{"description":"SET STNT URE SOFLX4.7X75 ","code_information":[{"code":"874276","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SET TUB IRR ","code_information":[{"code":"897313","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1795.00,"discounted_cash":1795.00,"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":296.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":134.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":342.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":238.74,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":323.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":448.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":484.65,"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":484.65,"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":484.65,"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":484.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":394.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":215.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":484.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":484.65,"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":484.65,"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":434.39,"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":240.53,"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":192.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":95.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":87.95,"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":319.51,"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":434.39,"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":319.51,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.50,"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":1795.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":251.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":396.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":357.20,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.50,"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":1436.00,"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":287.20,"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":166.94,"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":412.85,"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":376.95,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":610.30,"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":412.85,"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":484.65,"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":341.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1525.75,"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":1346.25,"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":166.94,"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":233.35,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":897.50,"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":1436.00,"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":1525.75,"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":897.50,"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":242.32,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2602.75,"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":511.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":807.75,"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":454.13,"methodology":"percent of total billed charges"}]}]},{"description":"SET XTN 2ML10 VLV MNFLD ","code_information":[{"code":"830763","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":444.00,"discounted_cash":444.00,"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":73.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":33.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":84.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":59.05,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":79.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":111.00,"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":119.88,"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":119.88,"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":119.88,"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":119.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":97.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":53.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":222.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":119.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":119.88,"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":119.88,"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":107.45,"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":59.50,"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":47.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":23.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":21.76,"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":79.03,"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":107.45,"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":79.03,"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":222.00,"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":444.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":62.16,"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":98.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":88.36,"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":222.00,"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":355.20,"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":71.04,"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":41.29,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":102.12,"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":93.24,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":150.96,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":102.12,"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":119.88,"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":84.36,"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":377.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":333.00,"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":41.29,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":57.72,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":222.00,"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":355.20,"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":377.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":222.00,"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":59.94,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":643.80,"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":126.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":199.80,"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":112.33,"methodology":"percent of total billed charges"}]}]},{"description":"SET XTN 2ND 34IN 1422928 ","code_information":[{"code":"843658","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":54.00,"discounted_cash":54.00,"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":8.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":4.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":10.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":7.18,"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":9.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":13.50,"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":14.58,"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":14.58,"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":14.58,"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":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":11.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":6.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"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":13.07,"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":7.24,"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":5.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.65,"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":9.61,"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":13.07,"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":9.61,"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":27.00,"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":54.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":7.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":11.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":10.75,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"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":43.20,"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":8.64,"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":5.02,"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":12.42,"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":11.34,"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":18.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":14.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":10.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":45.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":40.50,"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":5.02,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":7.02,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"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":43.20,"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":45.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":27.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":7.29,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":78.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":15.39,"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":24.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":13.66,"methodology":"percent of total billed charges"}]}]},{"description":"SET XTN L30IN LS IV PRM ","code_information":[{"code":"806474","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":30.00,"discounted_cash":30.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":4.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":3.99,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":7.50,"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":8.10,"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":8.10,"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":8.10,"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":8.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":6.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":3.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.10,"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":8.10,"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":7.26,"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":4.02,"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":3.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.47,"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":5.34,"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":7.26,"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":5.34,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15.00,"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":30.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":4.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":6.63,"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":5.97,"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":15.00,"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":24.00,"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":4.80,"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":2.79,"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":6.90,"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":6.30,"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":10.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6.90,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.10,"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":5.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":25.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":22.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":2.79,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15.00,"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":24.00,"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":25.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":15.00,"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":4.05,"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":43.50,"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":8.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13.50,"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":7.59,"methodology":"percent of total billed charges"}]}]},{"description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); corneovitreal adhesions ","code_information":[{"code":"360","type":"RC"},{"code":"65880","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":6926.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); goniosynechiae ","code_information":[{"code":"369","type":"RC"},{"code":"65865","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); goniosynechiae ","code_information":[{"code":"490","type":"RC"},{"code":"65865","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae ","code_information":[{"code":"360","type":"RC"},{"code":"65875","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Severing of tarsorrhaphy ","code_information":[{"code":"67710","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (1 or more stages) ","code_information":[{"code":"67031","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Sex chromatin identification; Barr bodies ","code_information":[{"code":"88130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.80,"maximum":37.76,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":26.97,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":19.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":17.80,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17.80,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":30.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21.40,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":19.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":18.07,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":37.76,"methodology":"fee schedule"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less ","code_information":[{"code":"11310","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm ","code_information":[{"code":"11311","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"11312","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm ","code_information":[{"code":"11313","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm ","code_information":[{"code":"11306","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"11307","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm ","code_information":[{"code":"11308","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm ","code_information":[{"code":"11308","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less ","code_information":[{"code":"11300","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"11302","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm ","code_information":[{"code":"11303","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"SHEATH ACC TPR 15FR 13FR ","code_information":[{"code":"905698","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH ACC WR 8.5FR 63CM ","code_information":[{"code":"931733","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":6958.00,"discounted_cash":6958.00,"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":1148.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":521.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1328.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":925.41,"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":1252.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1739.50,"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":1878.66,"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":1878.66,"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":1878.66,"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":1878.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1530.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":834.96,"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":3479.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1878.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1878.66,"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":1878.66,"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":1683.84,"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":932.37,"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":744.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":368.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":340.94,"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":1238.52,"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":1683.84,"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":1238.52,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3479.00,"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":6958.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":974.12,"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":1537.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1384.64,"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":3479.00,"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":5566.40,"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":1113.28,"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":647.09,"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":1600.34,"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":1461.18,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2365.72,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1600.34,"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":1878.66,"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":1322.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5914.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":5218.50,"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":647.09,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":904.54,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3479.00,"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":5566.40,"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":5914.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3479.00,"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":939.33,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":10089.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1983.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3131.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1760.37,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH GD 63CM 10FR .038 ","code_information":[{"code":"929085","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1938.00,"discounted_cash":1938.00,"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":319.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":370.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":257.75,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":348.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":484.50,"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":523.26,"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":523.26,"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":523.26,"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":523.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":426.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":232.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":969.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":523.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":523.26,"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":523.26,"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":469.00,"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":259.69,"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":207.37,"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":344.96,"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":469.00,"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":344.96,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":969.00,"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":1938.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":271.32,"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":428.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":385.66,"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":969.00,"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":1550.40,"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":310.08,"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":180.23,"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":445.74,"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":406.98,"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":658.92,"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":445.74,"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":523.26,"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":368.22,"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":1647.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1453.50,"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":180.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":251.94,"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":969.00,"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":1550.40,"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":1647.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":969.00,"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":261.63,"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":2810.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":552.33,"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":872.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":490.31,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH GD 7FR 45CM ","code_information":[{"code":"840293","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO 5FR 10CM ","code_information":[{"code":"809115","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":314.00,"discounted_cash":314.00,"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":51.81,"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":59.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":41.76,"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":56.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":78.50,"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":84.78,"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":84.78,"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":84.78,"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":84.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":69.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":37.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":157.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":84.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":84.78,"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":84.78,"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":75.99,"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":42.08,"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":33.60,"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":55.89,"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":75.99,"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":55.89,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":157.00,"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":314.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":43.96,"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":69.39,"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":62.49,"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":157.00,"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":251.20,"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":50.24,"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":29.20,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":72.22,"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":65.94,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":106.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":72.22,"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":84.78,"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":59.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":266.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":235.50,"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":29.20,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":40.82,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":157.00,"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":251.20,"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":266.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":157.00,"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":42.39,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":455.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":89.49,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":141.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":79.44,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO 6FR 10CM ","code_information":[{"code":"804799","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":341.00,"discounted_cash":341.00,"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":56.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":65.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":45.35,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":61.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":85.25,"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":92.07,"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":92.07,"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":92.07,"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":92.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":75.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":40.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":170.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":92.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":92.07,"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":92.07,"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":82.52,"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":45.69,"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":36.49,"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":60.70,"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":82.52,"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":60.70,"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":170.50,"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":341.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":47.74,"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":75.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":67.86,"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":170.50,"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":272.80,"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":54.56,"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":31.71,"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":78.43,"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":71.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":115.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":78.43,"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":92.07,"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":64.79,"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":289.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":255.75,"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":31.71,"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":44.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":170.50,"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":272.80,"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":289.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":170.50,"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":46.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":494.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":97.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":153.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":86.27,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO 7FR 25CM ","code_information":[{"code":"803489","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":682.00,"discounted_cash":682.00,"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":112.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":130.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":90.71,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":122.76,"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":170.50,"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":184.14,"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":184.14,"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":184.14,"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":184.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":150.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":81.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":341.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":184.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":184.14,"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":184.14,"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":165.04,"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":91.39,"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":72.97,"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":121.40,"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":165.04,"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":121.40,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":341.00,"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":682.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":95.48,"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":150.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":135.72,"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":341.00,"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":545.60,"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":109.12,"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":63.43,"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":156.86,"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":143.22,"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":231.88,"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":156.86,"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":184.14,"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":129.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":579.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":511.50,"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":63.43,"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":88.66,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":341.00,"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":545.60,"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":579.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":341.00,"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":92.07,"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":988.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":194.37,"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":306.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":172.55,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO 9FR 10CM ","code_information":[{"code":"809117","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":314.00,"discounted_cash":314.00,"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":51.81,"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":59.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":41.76,"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":56.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":78.50,"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":84.78,"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":84.78,"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":84.78,"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":84.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":69.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":37.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":157.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":84.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":84.78,"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":84.78,"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":75.99,"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":42.08,"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":33.60,"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":55.89,"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":75.99,"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":55.89,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":157.00,"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":314.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":43.96,"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":69.39,"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":62.49,"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":157.00,"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":251.20,"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":50.24,"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":29.20,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":72.22,"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":65.94,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":106.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":72.22,"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":84.78,"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":59.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":266.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":235.50,"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":29.20,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":40.82,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":157.00,"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":251.20,"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":266.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":157.00,"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":42.39,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":455.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":89.49,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":141.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":79.44,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO GW 10F 11CM ","code_information":[{"code":"813654","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":282.00,"discounted_cash":282.00,"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":46.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":53.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":37.51,"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":50.76,"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":70.50,"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":76.14,"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":76.14,"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":76.14,"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":76.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":62.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":33.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":76.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":76.14,"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":76.14,"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":68.24,"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":37.79,"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":30.17,"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":50.20,"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":68.24,"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":50.20,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"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":282.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":39.48,"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":62.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":56.12,"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":141.00,"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":225.60,"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":45.12,"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":26.23,"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":64.86,"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":59.22,"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":95.88,"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":64.86,"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":76.14,"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":53.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":239.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":211.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":26.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":36.66,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"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":225.60,"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":239.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":38.07,"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":408.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":80.37,"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":126.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":71.35,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH URE 35CM 12IN ","code_information":[{"code":"809504","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"Shortening of tendon, extensor, hand or finger, each tendon ","code_information":[{"code":"26477","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Shortening of tendon, flexor, hand or finger, each tendon ","code_information":[{"code":"26479","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC ","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":418.00,"maximum":60673.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29614.63,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":29470.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":27548.26,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":29759.09,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":50248.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":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":46136.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":25439.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":28892.32,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":19434.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12405.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10333.42,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":29181.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29181.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14185.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19434.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14185.78,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":24104.37,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":28892.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31781.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":38663.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":54976.49,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":28314.47,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29470.17,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":28892.32,"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":29470.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":32937.24,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":32359.40,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":28892.32,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":28314.47,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":28314.47,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":28314.47,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29470.17,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":28892.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":30625.86,"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":"NaphCare","plan_name":"Prison","standard_charge_dollar":60673.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36115.40,"methodology":"fee schedule"},{"payer_name":"Odyssey HealthCare","plan_name":"COMM","standard_charge_dollar":418.00,"methodology":"per diem"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":19603.02,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":28892.32,"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":30048.01,"methodology":"fee schedule"},{"payer_name":"Seasons Hospice","plan_name":"COMM","standard_charge_dollar":850.00,"methodology":"per diem"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":56340.02,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":30336.94,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":104.00,"standard_charge_algorithm":"Reimbursement will be 104% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":31781.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29181.24,"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":22817.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":28892.32,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":27534.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":22817.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":28892.32,"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":28892.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28025.55,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":56340.02,"methodology":"fee schedule"}]}]},{"description":"SHTH ACC 12FX20 ","code_information":[{"code":"804096","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SHTH SFE 9.5F 7120 ","code_information":[{"code":"840677","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":3256.00,"discounted_cash":3256.00,"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":537.24,"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":621.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":433.05,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":586.08,"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":814.00,"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":879.12,"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":879.12,"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":879.12,"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":879.12,"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":716.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":390.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1628.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":879.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":879.12,"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":879.12,"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":787.95,"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":436.30,"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":348.39,"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":579.57,"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":787.95,"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":579.57,"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":1628.00,"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":3256.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":455.84,"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":719.58,"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":647.94,"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":1628.00,"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":2604.80,"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":520.96,"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":302.81,"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":748.88,"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":683.76,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1107.04,"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":748.88,"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":879.12,"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":618.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2767.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2442.00,"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":302.81,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":423.28,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1628.00,"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":2604.80,"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":2767.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1628.00,"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":439.56,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4721.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":927.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1465.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":823.77,"methodology":"percent of total billed charges"}]}]},{"description":"SHTH SLT ATTN 6228SLT ","code_information":[{"code":"804445","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":718.00,"discounted_cash":718.00,"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":118.47,"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":137.14,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":95.49,"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":129.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":179.50,"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":193.86,"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":193.86,"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":193.86,"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":193.86,"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":157.96,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":86.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":359.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":193.86,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":193.86,"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":193.86,"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":173.76,"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":96.21,"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":76.83,"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":127.80,"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":173.76,"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":127.80,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":359.00,"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":718.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":100.52,"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":158.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":142.88,"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":359.00,"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":574.40,"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":114.88,"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":66.77,"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":165.14,"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":150.78,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":244.12,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":165.14,"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":193.86,"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":136.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":610.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":538.50,"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":66.77,"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":93.34,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":359.00,"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":574.40,"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":610.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":359.00,"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":96.93,"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":1041.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":204.63,"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":323.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":181.65,"methodology":"percent of total billed charges"}]}]},{"description":"SHTH SPR 7F 25 ","code_information":[{"code":"831666","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":675.00,"discounted_cash":675.00,"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":111.38,"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":128.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":89.78,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":121.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":168.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":182.25,"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":182.25,"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":182.25,"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":182.25,"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":148.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":81.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":337.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":182.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":182.25,"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":182.25,"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":163.35,"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":90.45,"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":72.22,"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":120.15,"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":163.35,"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":120.15,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":337.50,"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":675.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":94.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":149.18,"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":134.32,"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":337.50,"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":540.00,"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":108.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":62.78,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":155.25,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":141.75,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":229.50,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":155.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":182.25,"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":128.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":573.75,"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":506.25,"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":62.78,"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":87.75,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":337.50,"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":540.00,"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":573.75,"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":337.50,"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":91.13,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":978.75,"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":192.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":303.75,"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":170.78,"methodology":"percent of total billed charges"}]}]},{"description":"SHUNT CARDI TEMP 1.75MM ","code_information":[{"code":"812969","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5502.00,"discounted_cash":5502.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":907.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":412.65,"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":1050.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":731.77,"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":990.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1375.50,"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":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1210.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":660.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2751.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"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":1331.48,"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":737.27,"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":588.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":291.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":269.60,"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":979.36,"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":1331.48,"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":979.36,"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":2751.00,"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":5502.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":770.28,"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":1215.94,"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":1094.90,"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":2751.00,"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":4401.60,"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":880.32,"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":511.69,"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":1265.46,"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":1155.42,"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":1870.68,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1265.46,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1045.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4676.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4126.50,"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":511.69,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":715.26,"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":2751.00,"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":4401.60,"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":4676.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2751.00,"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":742.77,"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":7977.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1568.07,"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":2475.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1392.01,"methodology":"percent of total billed charges"}]}]},{"description":"SHUNT CV 14MM 2.5MM ","code_information":[{"code":"870903","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3917.00,"discounted_cash":3917.00,"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":646.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":293.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":748.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":520.96,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":705.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":979.25,"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":1057.59,"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":1057.59,"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":1057.59,"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":1057.59,"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":861.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":470.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1958.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1057.59,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1057.59,"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":1057.59,"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":947.91,"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":524.88,"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":419.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":207.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":191.93,"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":697.23,"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":947.91,"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":697.23,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1958.50,"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":3917.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":548.38,"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":865.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":779.48,"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":1958.50,"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":3133.60,"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":626.72,"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":364.28,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":900.91,"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":822.57,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1331.78,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":900.91,"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":1057.59,"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":744.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3329.45,"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":2937.75,"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":364.28,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":509.21,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1958.50,"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":3133.60,"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":3329.45,"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":1958.50,"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":528.79,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5679.65,"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":1116.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1762.65,"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":991.00,"methodology":"percent of total billed charges"}]}]},{"description":"SHUNT CV LNG 1.25 20.25 ","code_information":[{"code":"911026","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SHUNT CV TEMP 2.25MM ","code_information":[{"code":"812972","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5502.00,"discounted_cash":5502.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":907.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":412.65,"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":1050.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":731.77,"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":990.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1375.50,"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":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1210.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":660.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2751.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"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":1331.48,"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":737.27,"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":588.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":291.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":269.60,"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":979.36,"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":1331.48,"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":979.36,"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":2751.00,"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":5502.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":770.28,"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":1215.94,"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":1094.90,"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":2751.00,"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":4401.60,"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":880.32,"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":511.69,"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":1265.46,"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":1155.42,"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":1870.68,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1265.46,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1045.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4676.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4126.50,"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":511.69,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":715.26,"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":2751.00,"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":4401.60,"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":4676.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2751.00,"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":742.77,"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":7977.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1568.07,"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":2475.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1392.01,"methodology":"percent of total billed charges"}]}]},{"description":"SI ENDO W/RM FB ","code_information":[{"code":"117351","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7567.00,"discounted_cash":7567.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":567.52,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1362.06,"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":2043.09,"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":2043.09,"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":2043.09,"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":2043.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3783.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2043.09,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2043.09,"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":2043.09,"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":1831.21,"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":1013.98,"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":809.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":401.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":370.78,"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":1346.93,"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":1831.21,"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":1346.93,"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":3783.50,"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":7567.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1059.38,"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":3783.50,"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":6053.60,"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":1210.72,"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":703.73,"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":1740.41,"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":1740.41,"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":2043.09,"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":1437.73,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6431.95,"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":5675.25,"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":703.73,"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":3783.50,"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":6053.60,"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":6431.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3783.50,"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":1021.54,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":10972.15,"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":3405.15,"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":1914.45,"methodology":"percent of total billed charges"}]}]},{"description":"Sialic acid ","code_information":[{"code":"156700","type":"CDM"},{"code":"84275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.31,"maximum":28.22,"gross_charge":374.00,"discounted_cash":374.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":20.16,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":14.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":22.85,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":28.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":14.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":28.22,"methodology":"fee schedule"}]}]},{"description":"Sialolithotomy; parotid, extraoral or complicated intraoral ","code_information":[{"code":"42340","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sialolithotomy; parotid, extraoral or complicated intraoral ","code_information":[{"code":"42340","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral ","code_information":[{"code":"42330","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sickle cell disease, microfluidic flow adhesion (VCAM-1), whole blood ","code_information":[{"code":"0121U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504.11,"maximum":1069.32,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":524.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":544.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":539.75,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":763.80,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":611.04,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":549.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":519.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":519.38,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":636.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":560.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":509.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":509.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":544.84,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":570.30,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":504.11,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":504.11,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":509.20,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":611.04,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":865.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":509.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":605.95,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":534.66,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":534.66,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":1069.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":560.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":534.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":509.20,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":511.75,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":509.20,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":509.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":509.20,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":1069.32,"methodology":"fee schedule"}]}]},{"description":"Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"45330","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) ","code_information":[{"code":"360","type":"RC"},{"code":"45350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with biopsy, single or multiple ","code_information":[{"code":"45331","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with control of bleeding, any method ","code_information":[{"code":"360","type":"RC"},{"code":"45334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ","code_information":[{"code":"360","type":"RC"},{"code":"45337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance ","code_information":[{"code":"45335","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with endoscopic mucosal resection ","code_information":[{"code":"369","type":"RC"},{"code":"45349","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"369","type":"RC"},{"code":"45347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with removal of foreign body(s) ","code_information":[{"code":"360","type":"RC"},{"code":"45332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps ","code_information":[{"code":"45333","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) ","code_information":[{"code":"45342","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) ","code_information":[{"code":"45342","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC ","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":418.00,"maximum":33600.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":17231.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8645.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":29773.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":8603.40,"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":33600.00,"methodology":"case rate"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":8687.74,"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":5080.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":8434.70,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":24926.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":24541.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19879.00,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":8519.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8519.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":26971.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24926.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":26971.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5252.70,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":8434.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9278.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":8425.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":11980.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":8266.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8603.40,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":8434.70,"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":8603.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":9615.56,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":9446.87,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":8434.70,"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":8266.01,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8266.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":8266.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8603.40,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"case rate"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":8434.70,"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":8940.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":17712.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10543.38,"methodology":"fee schedule"},{"payer_name":"Odyssey HealthCare","plan_name":"COMM","standard_charge_dollar":418.00,"methodology":"per diem"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4271.79,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":8434.70,"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":8772.09,"methodology":"fee schedule"},{"payer_name":"Seasons Hospice","plan_name":"COMM","standard_charge_dollar":850.00,"methodology":"per diem"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":16447.67,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":8856.44,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":104.00,"standard_charge_algorithm":"Reimbursement will be 104% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":9278.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8519.05,"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":10400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7822 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":8434.70,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":8038.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7822 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":8434.70,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":8434.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8181.66,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":16447.67,"methodology":"fee schedule"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm ","code_information":[{"code":"12016","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less ","code_information":[{"code":"12011","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm ","code_information":[{"code":"12013","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm ","code_information":[{"code":"12017","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm ","code_information":[{"code":"12015","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm ","code_information":[{"code":"12018","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm ","code_information":[{"code":"12005","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm ","code_information":[{"code":"12005","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm ","code_information":[{"code":"12005","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less ","code_information":[{"code":"12001","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cm ","code_information":[{"code":"12006","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm ","code_information":[{"code":"12004","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; external, simple (trephine operation) ","code_information":[{"code":"31070","type":"CPT"},{"code":"369","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":6926.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; nonobliterative, with osteoplastic flap, brow incision ","code_information":[{"code":"31086","type":"CPT"},{"code":"499","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; nonobliterative, with osteoplastic flap, coronal incision ","code_information":[{"code":"31087","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; obliterative, with osteoplastic flap, brow incision ","code_information":[{"code":"31084","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele ","code_information":[{"code":"369","type":"RC"},{"code":"58263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele ","code_information":[{"code":"481","type":"RC"},{"code":"58263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele ","code_information":[{"code":"490","type":"RC"},{"code":"58263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele ","code_information":[{"code":"361","type":"RC"},{"code":"58270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; ","code_information":[{"code":"58290","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; ","code_information":[{"code":"58290","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":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"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH COLPO-URETHROCYSTOPEXY (MARSHALL-MARCHETTI-KRANTZ TYPE, PEREYRA TYPE) WITH OR WITHOUT ENDOSCOPIC CONTROL ","code_information":[{"code":"490","type":"RC"},{"code":"58293","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7069.00,"maximum":8652.00,"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"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) ","code_information":[{"code":"360","type":"RC"},{"code":"58291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele ","code_information":[{"code":"481","type":"RC"},{"code":"58292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":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"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele ","code_information":[{"code":"360","type":"RC"},{"code":"58294","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, with total or partial vaginectomy; ","code_information":[{"code":"361","type":"RC"},{"code":"58275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Vaginal hysterectomy, with total or partial vaginectomy; ","code_information":[{"code":"499","type":"RC"},{"code":"58275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy) ","code_information":[{"code":"499","type":"RC"},{"code":"57109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vaginoplasty for intersex state ","code_information":[{"code":"369","type":"RC"},{"code":"57335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"VAGUS NERVE BLOCKING THERAPY (MORBID OBESITY); LAPAROSCOPIC REVISION OR REPLACEMENT OF VAGAL TRUNK NEUROSTIMULATOR ELECTRODE ARRAY, INCLUDING CONNECTION TO EXISTING PULSE GENERATOR ","code_information":[{"code":"0313T","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"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":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"}]}]},{"description":"VAGUS NERVE BLOCKING THERAPY (MORBID OBESITY); REPLACEMENT OF PULSE GENERATOR ","code_information":[{"code":"0316T","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"maximum":13833.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13778.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13833.00,"methodology":"case rate"}]}]},{"description":"Valproic acid (dipropylacetic acid); free ","code_information":[{"code":"80165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.40,"maximum":28.43,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":20.31,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":23.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.11,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":28.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":28.43,"methodology":"fee schedule"}]}]},{"description":"VALVE HMSTS BORE SM ","code_information":[{"code":"913955","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":538.00,"discounted_cash":538.00,"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":88.77,"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":40.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":102.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":71.55,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":96.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":134.50,"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":145.26,"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":145.26,"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":145.26,"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":145.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":118.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":64.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":269.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":145.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":145.26,"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":145.26,"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":130.20,"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":72.09,"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":57.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":28.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":26.36,"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":95.76,"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":130.20,"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":95.76,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":269.00,"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":538.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":75.32,"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":118.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":107.06,"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":269.00,"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":430.40,"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":86.08,"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":50.03,"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":123.74,"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":112.98,"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":182.92,"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":123.74,"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":145.26,"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":102.22,"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":457.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":403.50,"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":50.03,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":69.94,"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":269.00,"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":430.40,"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":457.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":269.00,"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":72.63,"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":780.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":153.33,"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":242.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":136.11,"methodology":"percent of total billed charges"}]}]},{"description":"VALVE PEEP 5-20CM 30MM ","code_information":[{"code":"932550","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":47.00,"discounted_cash":47.00,"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":7.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.52,"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":8.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":6.25,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":8.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":11.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.69,"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":12.69,"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":12.69,"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":12.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":10.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":5.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.69,"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":12.69,"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":11.37,"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":6.30,"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":5.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.30,"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":8.37,"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":11.37,"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":8.37,"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":23.50,"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":47.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":6.58,"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":10.39,"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":9.35,"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":23.50,"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":37.60,"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":7.52,"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":4.37,"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":10.81,"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":9.87,"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":15.98,"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":10.81,"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":12.69,"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":8.93,"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":39.95,"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":35.25,"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":4.37,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":6.11,"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":23.50,"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":37.60,"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":39.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.50,"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":6.34,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":68.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":13.39,"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":21.15,"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":11.89,"methodology":"percent of total billed charges"}]}]},{"description":"VASC EMBOL ART VEN HEM ","code_information":[{"code":"790767","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":16016.00,"discounted_cash":16016.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1201.20,"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":2882.88,"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":4324.32,"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":4324.32,"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":4324.32,"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":4324.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8008.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":4324.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":4324.32,"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":4324.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":848.85,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":784.78,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8008.00,"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":16016.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":2242.24,"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":8008.00,"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":12812.80,"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":2562.56,"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":1489.49,"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":3683.68,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":3683.68,"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":4324.32,"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":3043.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13613.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":12012.00,"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":1489.49,"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":8008.00,"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":12812.80,"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":13613.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8008.00,"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":2162.16,"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":23223.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7207.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":4052.05,"methodology":"percent of total billed charges"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, ot ","code_information":[{"code":"37242","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6434.00,"maximum":13042.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11411.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10152.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10152.00,"methodology":"case rate"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, ot ","code_information":[{"code":"37242","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":21400.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11411.00,"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":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10152.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10152.00,"methodology":"case rate"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, othe ","code_information":[{"code":"361","type":"RC"},{"code":"37241","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":21400.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10567.00,"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":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10152.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10152.00,"methodology":"case rate"}]}]},{"description":"Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, othe ","code_information":[{"code":"37241","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":21400.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10567.00,"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":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11895.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10152.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10152.00,"methodology":"case rate"}]}]},{"description":"Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) ","code_information":[{"code":"361","type":"RC"},{"code":"55250","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) ","code_information":[{"code":"55250","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vasotomy for vasograms, seminal vesiculograms, or epididymograms, unilateral or bilateral ","code_information":[{"code":"361","type":"RC"},{"code":"55300","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"55200","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"55200","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure) ","code_information":[{"code":"55200","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vasovasostomy, vasovasorrhaphy ","code_information":[{"code":"55400","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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Venipuncture, cutdown; age 1 or over ","code_information":[{"code":"36425","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Venipuncture, cutdown; younger than age 1 year ","code_information":[{"code":"36420","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Venous catheterization for selective organ blood sampling ","code_information":[{"code":"361","type":"RC"},{"code":"36500","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Venous valve transposition, any vein donor ","code_information":[{"code":"34510","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Venous valve transposition, any vein donor ","code_information":[{"code":"34510","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Ventilating tube removal requiring general anesthesia ","code_information":[{"code":"69424","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":2580.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment ","code_information":[{"code":"360","type":"RC"},{"code":"61026","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; without injection ","code_information":[{"code":"61020","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Vermilionectomy (lip shave), with mucosal advancement ","code_information":[{"code":"40500","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Vesiculectomy, any approach ","code_information":[{"code":"369","type":"RC"},{"code":"55650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Vesiculectomy, any approach ","code_information":[{"code":"481","type":"RC"},{"code":"55650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Vesiculectomy, any approach ","code_information":[{"code":"490","type":"RC"},{"code":"55650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Vesiculotomy; ","code_information":[{"code":"55600","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vesiculotomy; complicated ","code_information":[{"code":"55605","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"VEST BRN SHRTSLV 38-45IN ","code_information":[{"code":"857226","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"Vestibuloplasty; complex (including ridge extension, muscle repositioning) ","code_information":[{"code":"361","type":"RC"},{"code":"40845","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; complex (including ridge extension, muscle repositioning) ","code_information":[{"code":"40845","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; complex (including ridge extension, muscle repositioning) ","code_information":[{"code":"40845","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; entire arch ","code_information":[{"code":"40844","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; posterior, bilateral ","code_information":[{"code":"40843","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vestibuloplasty; posterior, bilateral ","code_information":[{"code":"40843","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6926.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"VIMENTIN PEROX AB ","code_information":[{"code":"156005","type":"CDM"},{"code":"88342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":854.00,"discounted_cash":854.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":153.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":213.50,"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":230.58,"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":230.58,"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":230.58,"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":230.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":187.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":102.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":427.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":230.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":230.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":230.58,"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":427.00,"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":854.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":119.56,"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":427.00,"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":683.20,"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":136.64,"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":79.42,"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":196.42,"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":179.34,"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":290.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":196.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":230.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":162.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":725.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":640.50,"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":79.42,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":111.02,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":427.00,"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":683.20,"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":725.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":427.00,"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":115.29,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1238.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":243.39,"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":384.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":216.06,"methodology":"percent of total billed charges"}]}]},{"description":"Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect ","code_information":[{"code":"87252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25.81,"maximum":54.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":39.11,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":28.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":32.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27.89,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":29.20,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31.28,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":44.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":31.02,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":27.37,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":27.37,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":54.75,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":28.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":26.20,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":54.75,"methodology":"fee schedule"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; ","code_information":[{"code":"369","type":"RC"},{"code":"67036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; ","code_information":[{"code":"481","type":"RC"},{"code":"67036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"maximum":13320.00,"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":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; ","code_information":[{"code":"490","type":"RC"},{"code":"67036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation ","code_information":[{"code":"490","type":"RC"},{"code":"67040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation ","code_information":[{"code":"67040","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":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponad ","code_information":[{"code":"369","type":"RC"},{"code":"67042","type":"CPT"}],"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":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponad ","code_information":[{"code":"499","type":"RC"},{"code":"67042","type":"CPT"}],"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":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) and la ","code_information":[{"code":"499","type":"RC"},{"code":"67043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure) ","code_information":[{"code":"51797","type":"CPT"},{"code":"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure) ","code_information":[{"code":"51797","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Vulvectomy simple; complete ","code_information":[{"code":"499","type":"RC"},{"code":"56625","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vulvectomy simple; partial ","code_information":[{"code":"481","type":"RC"},{"code":"56620","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vulvectomy simple; partial ","code_information":[{"code":"490","type":"RC"},{"code":"56620","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy ","code_information":[{"code":"360","type":"RC"},{"code":"56637","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":17081.00,"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":17081.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":17081.00,"methodology":"case rate"}]}]},{"description":"Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy ","code_information":[{"code":"369","type":"RC"},{"code":"56632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":17081.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11895.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17081.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":17081.00,"methodology":"case rate"}]}]},{"description":"Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy ","code_information":[{"code":"481","type":"RC"},{"code":"56632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":17081.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11895.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17081.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":17081.00,"methodology":"case rate"}]}]},{"description":"WAND SEALER W/LGT 11IN ","code_information":[{"code":"812177","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5402.00,"discounted_cash":5402.00,"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":891.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":405.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1031.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":718.47,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":972.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1350.50,"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":1458.54,"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":1458.54,"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":1458.54,"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":1458.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1188.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":648.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2701.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1458.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1458.54,"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":1458.54,"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":1307.28,"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":723.87,"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":578.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":286.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":264.70,"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":961.56,"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":1307.28,"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":961.56,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2701.00,"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":5402.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":756.28,"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":1193.84,"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":1075.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2701.00,"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":4321.60,"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":864.32,"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":502.39,"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":1242.46,"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":1134.42,"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":1836.68,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1242.46,"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":1458.54,"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":1026.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4591.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4051.50,"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":502.39,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":702.26,"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":2701.00,"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":4321.60,"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":4591.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2701.00,"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":729.27,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7832.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1539.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2430.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1366.71,"methodology":"percent of total billed charges"}]}]},{"description":"WASHER EX FIX THK 4MM ","code_information":[{"code":"830083","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":646.00,"discounted_cash":646.00,"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":106.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":48.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":123.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":85.92,"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":116.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":161.50,"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":174.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":174.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":174.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":174.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":142.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":77.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":323.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":174.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":174.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":174.42,"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":156.33,"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":86.56,"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":69.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":34.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":31.65,"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":114.99,"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":156.33,"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":114.99,"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":323.00,"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":646.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":90.44,"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":142.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":128.55,"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":323.00,"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":516.80,"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":103.36,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":60.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":148.58,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":135.66,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":219.64,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":148.58,"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":174.42,"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":122.74,"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":549.10,"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":484.50,"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":60.08,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":83.98,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":323.00,"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":516.80,"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":549.10,"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":323.00,"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":87.21,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":936.70,"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":184.11,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":290.70,"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":163.44,"methodology":"percent of total billed charges"}]}]},{"description":"WASHER HFMN LRF 4MM BL ","code_information":[{"code":"871430","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1378.00,"discounted_cash":1378.00,"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":227.37,"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":103.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":263.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":183.27,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":248.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":344.50,"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":372.06,"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":372.06,"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":372.06,"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":372.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":303.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":165.36,"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":689.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":372.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":372.06,"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":372.06,"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":333.48,"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":184.65,"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":147.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":73.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":67.52,"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":245.28,"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":333.48,"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":245.28,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":689.00,"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":1378.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":192.92,"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":304.54,"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":274.22,"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":689.00,"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":1102.40,"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":220.48,"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":128.15,"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":316.94,"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":289.38,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":468.52,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":316.94,"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":372.06,"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":261.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1171.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1033.50,"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":128.15,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":179.14,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":689.00,"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":1102.40,"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":1171.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":689.00,"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":186.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1998.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":392.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":620.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":348.63,"methodology":"percent of total billed charges"}]}]},{"description":"WB LR CMV NEG ","code_information":[{"code":"157376","type":"CDM"},{"code":"P9051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":575.00,"discounted_cash":575.00,"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":94.88,"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":109.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":76.47,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":103.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":143.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":155.25,"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":155.25,"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":155.25,"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":155.25,"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":126.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":69.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":287.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":155.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":155.25,"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":155.25,"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":139.15,"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":77.05,"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":61.52,"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":102.35,"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":139.15,"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":102.35,"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":287.50,"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":575.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":80.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":127.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":114.42,"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":287.50,"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":460.00,"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":92.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":53.48,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":132.25,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":120.75,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":195.50,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":132.25,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":155.25,"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":109.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":488.75,"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":431.25,"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":53.48,"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":74.75,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":287.50,"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":460.00,"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":488.75,"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":287.50,"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":77.63,"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":833.75,"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":163.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":258.75,"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":145.47,"methodology":"percent of total billed charges"}]}]},{"description":"Wedge excision of skin of nail fold (eg, for ingrown toenail) ","code_information":[{"code":"11765","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Wedge excision of skin of nail fold (eg, for ingrown toenail) ","code_information":[{"code":"11765","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"WHIRLPOOL PT ","code_information":[{"code":"122344","type":"CDM"},{"code":"97022","type":"CPT"}],"standard_charges":[{"modifiers":"GP","modifiers_description":"Services delivered under an outpatient physical therapy plan of care","setting":"outpatient","gross_charge":2043.00,"discounted_cash":2043.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":367.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":510.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":551.61,"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":551.61,"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":551.61,"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":551.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":449.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":245.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1021.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":551.61,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":551.61,"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":551.61,"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":1021.50,"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":2043.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":286.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":451.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":406.56,"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":1021.50,"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":1634.40,"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":326.88,"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":190.00,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":469.89,"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":429.03,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":694.62,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":469.89,"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":551.61,"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":388.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1736.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1532.25,"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":190.00,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":265.59,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1021.50,"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":1634.40,"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":1736.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1021.50,"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":275.81,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2962.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":582.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":919.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":516.88,"methodology":"percent of total billed charges"}]}]},{"description":"WIRE FX 1.8MM 400MM OLV ","code_information":[{"code":"825600","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3744.00,"discounted_cash":3744.00,"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":617.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":280.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":715.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":497.95,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":673.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":936.00,"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":1010.88,"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":1010.88,"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":1010.88,"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":1010.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":823.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":449.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1872.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1010.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1010.88,"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":1010.88,"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":906.05,"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":501.70,"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":400.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":198.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":183.46,"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":666.43,"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":906.05,"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":666.43,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1872.00,"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":3744.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":524.16,"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":827.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":745.06,"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":1872.00,"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":2995.20,"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":599.04,"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":348.19,"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":861.12,"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":786.24,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1272.96,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":861.12,"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":1010.88,"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":711.36,"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":3182.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2808.00,"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":348.19,"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":486.72,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1872.00,"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":2995.20,"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":3182.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1872.00,"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":505.44,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5428.80,"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":1067.04,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1684.80,"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":947.23,"methodology":"percent of total billed charges"}]}]},{"description":"WIRE FX 1.8MM SHORT ","code_information":[{"code":"881167","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"WIRE GD ORTH 1.4MM ","code_information":[{"code":"848086","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":682.00,"discounted_cash":682.00,"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":112.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":130.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":90.71,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":122.76,"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":170.50,"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":184.14,"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":184.14,"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":184.14,"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":184.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":150.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":81.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":341.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":184.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":184.14,"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":184.14,"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":165.04,"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":91.39,"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":72.97,"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":121.40,"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":165.04,"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":121.40,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":341.00,"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":682.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":95.48,"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":150.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":135.72,"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":341.00,"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":545.60,"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":109.12,"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":63.43,"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":156.86,"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":143.22,"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":231.88,"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":156.86,"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":184.14,"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":129.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":579.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":511.50,"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":63.43,"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":88.66,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":341.00,"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":545.60,"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":579.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":341.00,"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":92.07,"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":988.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":194.37,"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":306.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":172.55,"methodology":"percent of total billed charges"}]}]},{"description":"WIRE GD SURG THRD SHARP ","code_information":[{"code":"802219","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":897.00,"discounted_cash":897.00,"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":148.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":171.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":119.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":161.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":224.25,"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":242.19,"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":242.19,"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":242.19,"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":242.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":197.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":107.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":242.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":242.19,"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":242.19,"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":217.07,"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":120.20,"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":95.98,"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":159.67,"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":217.07,"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":159.67,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":897.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":125.58,"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":198.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":178.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":717.60,"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":143.52,"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":83.42,"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":206.31,"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":188.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":304.98,"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":206.31,"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":242.19,"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":170.43,"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":762.45,"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":672.75,"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":83.42,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":116.61,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":717.60,"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":762.45,"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":448.50,"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":121.09,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1300.65,"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":255.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":403.65,"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":226.94,"methodology":"percent of total billed charges"}]}]},{"description":"WIRE GLD .038 150 STRGHT ","code_information":[{"code":"868653","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1025.00,"discounted_cash":1025.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":169.13,"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":195.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":136.32,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":184.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":256.25,"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":276.75,"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":276.75,"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":276.75,"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":276.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":225.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":123.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":512.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":276.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":276.75,"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":276.75,"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":248.05,"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":137.35,"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":109.67,"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":182.45,"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":248.05,"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":182.45,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":512.50,"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":1025.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":143.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":226.53,"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":203.97,"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":512.50,"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":820.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":164.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":95.33,"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":235.75,"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":215.25,"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":348.50,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":235.75,"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":276.75,"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":194.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":871.25,"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":768.75,"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":95.33,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":133.25,"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":512.50,"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":820.00,"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":871.25,"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":512.50,"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":138.38,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1486.25,"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":292.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":461.25,"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":259.32,"methodology":"percent of total billed charges"}]}]},{"description":"WIRE PCNG 20.3CM 1/2IN ","code_information":[{"code":"849185","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":462.00,"discounted_cash":462.00,"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":76.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":34.65,"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":88.24,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":61.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":83.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":115.50,"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":124.74,"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":124.74,"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":124.74,"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":124.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":101.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":55.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":231.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":124.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":124.74,"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":124.74,"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":111.80,"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":61.91,"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":49.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":24.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":22.64,"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":82.24,"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":111.80,"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":82.24,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":231.00,"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":462.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":64.68,"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":102.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":91.94,"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":231.00,"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":369.60,"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":73.92,"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":42.97,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":106.26,"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":97.02,"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":157.08,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":106.26,"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":124.74,"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":87.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":392.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":346.50,"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":42.97,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":60.06,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":231.00,"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":369.60,"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":392.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":231.00,"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":62.37,"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":669.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":131.67,"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":207.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":116.89,"methodology":"percent of total billed charges"}]}]},{"description":"WRENCH OASYS AUDIBLE TRQ ","code_information":[{"code":"873204","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"WRNCH ALN 5 EBI LP ","code_information":[{"code":"868549","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2501.00,"discounted_cash":2501.00,"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":412.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":187.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":477.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":332.63,"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":450.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":625.25,"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":675.27,"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":675.27,"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":675.27,"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":675.27,"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":550.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":300.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1250.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":675.27,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":675.27,"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":675.27,"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":605.24,"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":335.13,"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":267.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":132.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":122.55,"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":445.18,"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":605.24,"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":445.18,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1250.50,"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":2501.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":350.14,"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":552.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":497.70,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1250.50,"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":2000.80,"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":400.16,"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":232.59,"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":575.23,"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":525.21,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":850.34,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":575.23,"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":675.27,"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":475.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2125.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1875.75,"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":232.59,"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":325.13,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1250.50,"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":2000.80,"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":2125.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1250.50,"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":337.63,"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":3626.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":712.78,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1125.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":632.75,"methodology":"percent of total billed charges"}]}]},{"description":"XENON XE133 GAS DX 10MCI ","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"122613","type":"CDM"},{"code":"A9558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1288.00,"discounted_cash":1288.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":231.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":322.00,"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":347.76,"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":347.76,"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":347.76,"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":347.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":283.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":154.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":644.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":347.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":347.76,"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":347.76,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":644.00,"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":1288.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":180.32,"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":284.65,"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":256.31,"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":644.00,"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":1030.40,"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":206.08,"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":119.78,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":296.24,"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":270.48,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":437.92,"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":296.24,"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":347.76,"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":244.72,"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":1094.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":966.00,"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":119.78,"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":167.44,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":644.00,"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":1030.40,"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":1094.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":644.00,"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":173.88,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1867.60,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":367.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":579.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":325.86,"methodology":"percent of total billed charges"}]}]},{"description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy ","code_information":[{"code":"499","type":"RC"},{"code":"50555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":6926.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with ","code_information":[{"code":"50557","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":11411.00,"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":11411.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"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":"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":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or ","code_information":[{"code":"360","type":"RC"},{"code":"50553","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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; ","code_information":[{"code":"490","type":"RC"},{"code":"50570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":4296.00,"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":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":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy ","code_information":[{"code":"490","type":"RC"},{"code":"50575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy ","code_information":[{"code":"50575","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without bio ","code_information":[{"code":"369","type":"RC"},{"code":"50576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without bio ","code_information":[{"code":"481","type":"RC"},{"code":"50576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without bio ","code_information":[{"code":"490","type":"RC"},{"code":"50576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without bio ","code_information":[{"code":"50576","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"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":"369","type":"RC"},{"code":"50580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":6926.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"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":"481","type":"RC"},{"code":"50580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":6926.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"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":"490","type":"RC"},{"code":"50580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":6926.00,"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":6926.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"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":6926.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"RENALCRYO PROBE 2.4MM ","code_information":[{"code":"841203","type":"CDM"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":8638.00,"discounted_cash":8638.00,"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":1425.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1649.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":1148.85,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1554.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2159.50,"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":2332.26,"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":2332.26,"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":2332.26,"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":2332.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1900.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1036.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4319.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2332.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2332.26,"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":2332.26,"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":2090.40,"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":1157.49,"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":924.27,"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":1537.56,"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":2090.40,"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":1537.56,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4319.00,"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":8638.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1209.32,"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":1909.00,"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":1718.96,"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":4319.00,"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":6910.40,"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":1382.08,"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":803.33,"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":1986.74,"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":1813.98,"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":2936.92,"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":1986.74,"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":2332.26,"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":1641.22,"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":7342.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6478.50,"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":803.33,"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":1122.94,"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":4319.00,"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":6910.40,"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":7342.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4319.00,"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":1166.13,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":12525.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2461.83,"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":3887.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":2185.41,"methodology":"percent of total billed charges"}]}]},{"description":"Renin ","code_information":[{"code":"156695","type":"CDM"},{"code":"84244","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21.77,"maximum":46.18,"gross_charge":349.00,"discounted_cash":349.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":23.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":32.98,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":23.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":27.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.53,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":24.63,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":21.89,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":21.99,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":37.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":26.17,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":46.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":22.10,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":46.18,"methodology":"fee schedule"}]}]},{"description":"REPAIR ARTERIAL BLOCKAGE ","code_information":[{"code":"35458","type":"CPT"},{"code":"750","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":"REPAIR ARTERIAL BLOCKAGE ","code_information":[{"code":"35458","type":"CPT"},{"code":"790","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":"Repair blood vessel with graft other than vein; lower extremity ","code_information":[{"code":"35286","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13545.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel with graft other than vein; neck ","code_information":[{"code":"35261","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel with graft other than vein; neck ","code_information":[{"code":"35261","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel with graft other than vein; neck ","code_information":[{"code":"35261","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel with vein graft; lower extremity ","code_information":[{"code":"35256","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"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":13545.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel with vein graft; lower extremity ","code_information":[{"code":"35256","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13545.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel with vein graft; neck ","code_information":[{"code":"35231","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel, direct; hand, finger ","code_information":[{"code":"35207","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":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel, direct; hand, finger ","code_information":[{"code":"35207","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel, direct; lower extremity ","code_information":[{"code":"35226","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Repair blood vessel, direct; neck ","code_information":[{"code":"35201","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13545.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Repair choanal atresia; intranasal ","code_information":[{"code":"30540","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Repair choanal atresia; intranasal ","code_information":[{"code":"30540","type":"CPT"},{"code":"499","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Repair choanal atresia; transpalatine ","code_information":[{"code":"30545","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); INCARCERATED OR STRANGULATED ","code_information":[{"code":"361","type":"RC"},{"code":"49572","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 EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); REDUCIBLE (SEPARATE PROCEDURE) ","code_information":[{"code":"361","type":"RC"},{"code":"49570","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 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 fistula; oromaxillary (combine with 31030 if antrotomy is included) ","code_information":[{"code":"30580","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Repair inguinal hernia, sliding, any age ","code_information":[{"code":"481","type":"RC"},{"code":"49525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair inguinal hernia, sliding, any age ","code_information":[{"code":"490","type":"RC"},{"code":"49525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair inguinal hernia, sliding, any age ","code_information":[{"code":"49525","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"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":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair initial femoral hernia, any age; reducible ","code_information":[{"code":"490","type":"RC"},{"code":"49550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED ","code_information":[{"code":"360","type":"RC"},{"code":"49561","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 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 5 years or older; incarcerated or strangulated ","code_information":[{"code":"369","type":"RC"},{"code":"49507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"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":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated ","code_information":[{"code":"490","type":"RC"},{"code":"49507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"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":"361","type":"RC"},{"code":"49501","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"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":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible ","code_information":[{"code":"360","type":"RC"},{"code":"49500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"REPAIR JEJUNOSTOMY KIT ","code_information":[{"code":"873240","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"Repair lateral collateral ligament, elbow, with local tissue ","code_information":[{"code":"24343","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair lip, full thickness; vermilion only ","code_information":[{"code":"369","type":"RC"},{"code":"40650","type":"CPT"}],"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Repair lumbar hernia ","code_information":[{"code":"490","type":"RC"},{"code":"49540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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":6926.00,"methodology":"case 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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair macrodactylia, each digit ","code_information":[{"code":"26590","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Repair macrodactylia, each digit ","code_information":[{"code":"26590","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Repair macrodactylia, each digit ","code_information":[{"code":"26590","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Repair macrodactylia, each digit ","code_information":[{"code":"26590","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Repair medial collateral ligament, elbow, with local tissue ","code_information":[{"code":"24345","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair nasal septal perforations ","code_information":[{"code":"30630","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Repair nasal septal perforations ","code_information":[{"code":"30630","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or internal fixation) ","code_information":[{"code":"26546","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":6926.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"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":24128.00,"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":17299.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":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":"360","type":"RC"},{"code":"46707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Repair of anterior palate, including vomer flap ","code_information":[{"code":"42235","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Repair of anterior palate, including vomer flap ","code_information":[{"code":"42235","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Repair of anterior palate, including vomer flap ","code_information":[{"code":"42235","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Repair of blepharoptosis; (tarso) levator resection or advancement, external approach ","code_information":[{"code":"67904","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) ","code_information":[{"code":"499","type":"RC"},{"code":"67902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"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":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s) ","code_information":[{"code":"27602","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s), with debridement of nonviable muscle and/or nerve ","code_information":[{"code":"27894","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s), with debridement of nonviable muscle and/or nerve ","code_information":[{"code":"27894","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, leg; posterior compartment(s) only ","code_information":[{"code":"27601","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"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":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":7571.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"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":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":7571.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); ","code_information":[{"code":"27496","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); ","code_information":[{"code":"27496","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); ","code_information":[{"code":"27496","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"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":"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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Decompression fingers and/or hand, injection injury (eg, grease gun) ","code_information":[{"code":"26035","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Decompression internal auditory canal ","code_information":[{"code":"481","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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Decompression internal auditory canal ","code_information":[{"code":"490","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 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Decompression internal auditory canal ","code_information":[{"code":"69960","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":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Decompression of orbit only, transcranial approach ","code_information":[{"code":"369","type":"RC"},{"code":"61330","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":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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Decompression of orbit only, transcranial approach ","code_information":[{"code":"499","type":"RC"},{"code":"61330","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":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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Decompression; unspecified nerve(s) (specify) ","code_information":[{"code":"499","type":"RC"},{"code":"64722","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"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":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Decompressive fasciotomy, hand (excludes 26035) ","code_information":[{"code":"26037","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Decortication and parietal pleurectomy ","code_information":[{"code":"32320","type":"CPT"},{"code":"360","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":7133.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7133.00,"methodology":"case rate"}]}]},{"description":"Decortication and parietal pleurectomy ","code_information":[{"code":"32320","type":"CPT"},{"code":"490","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":7133.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7133.00,"methodology":"case rate"}]}]},{"description":"Decortication and parietal pleurectomy ","code_information":[{"code":"32320","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13042.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":13042.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11895.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7133.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7133.00,"methodology":"case rate"}]}]},{"description":"Decortication, pulmonary (separate procedure); total ","code_information":[{"code":"32220","type":"CPT"},{"code":"360","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":7133.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7133.00,"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":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"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":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"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":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Delay of flap or sectioning of flap (division and inset); at trunk ","code_information":[{"code":"15600","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Delay of flap or sectioning of flap (division and inset); at trunk ","code_information":[{"code":"15600","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Delivery of placenta (separate procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"59414","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Delivery of placenta (separate procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"59414","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Delivery of placenta (separate procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"59414","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"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":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"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":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Dermabrasion; regional, other than face ","code_information":[{"code":"15782","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Dermabrasion; superficial, any site (eg, tattoo removal) ","code_information":[{"code":"15783","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) ","code_information":[{"code":"15780","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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) ","code_information":[{"code":"15780","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) ","code_information":[{"code":"15780","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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"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":"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children ","code_information":[{"code":"15130","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":8652.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"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":"360","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 vascular proliferative lesions; 15 or more lesions ","code_information":[{"code":"17111","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions ","code_information":[{"code":"17111","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions ","code_information":[{"code":"17111","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Enucleation of eye; with implant, muscles attached to implant ","code_information":[{"code":"481","type":"RC"},{"code":"65105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Enucleation of eye; with implant, muscles attached to implant ","code_information":[{"code":"490","type":"RC"},{"code":"65105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Enucleation of eye; with implant, muscles attached to implant ","code_information":[{"code":"65105","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Enucleation of eye; with implant, muscles not attached to implant ","code_information":[{"code":"490","type":"RC"},{"code":"65103","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Enucleation of eye; without implant ","code_information":[{"code":"360","type":"RC"},{"code":"65101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"EP INTRACARD DX TX ","code_information":[{"code":"596575","type":"CDM"},{"code":"93655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":11108.00,"discounted_cash":11108.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1999.44,"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":2999.16,"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":2999.16,"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":2999.16,"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":2999.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5554.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2999.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2999.16,"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":2999.16,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5554.00,"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":11108.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1555.12,"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":5554.00,"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":8886.40,"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":1777.28,"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":2110.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":9441.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":8331.00,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1444.04,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5554.00,"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":8886.40,"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":9441.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5554.00,"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":1499.58,"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":16106.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4998.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":2810.32,"methodology":"percent of total billed charges"}]}]},{"description":"Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and child ","code_information":[{"code":"15116","type":"CPT"},{"code":"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children ","code_information":[{"code":"15115","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children ","code_information":[{"code":"15115","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children ","code_information":[{"code":"15115","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Epidermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedur ","code_information":[{"code":"15111","type":"CPT"},{"code":"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children ","code_information":[{"code":"15110","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children ","code_information":[{"code":"15110","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children ","code_information":[{"code":"15110","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Epididymectomy; bilateral ","code_information":[{"code":"361","type":"RC"},{"code":"54861","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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Epididymectomy; bilateral ","code_information":[{"code":"481","type":"RC"},{"code":"54861","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Epididymectomy; unilateral ","code_information":[{"code":"369","type":"RC"},{"code":"54860","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Epididymovasostomy, anastomosis of epididymis to vas deferens; bilateral ","code_information":[{"code":"360","type":"RC"},{"code":"54901","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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Epididymovasostomy, anastomosis of epididymis to vas deferens; unilateral ","code_information":[{"code":"369","type":"RC"},{"code":"54900","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Epididymovasostomy, anastomosis of epididymis to vas deferens; unilateral ","code_information":[{"code":"499","type":"RC"},{"code":"54900","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Epikeratoplasty ","code_information":[{"code":"361","type":"RC"},{"code":"65767","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulna ","code_information":[{"code":"25455","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 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Epiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna ","code_information":[{"code":"25450","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Episiotomy or vaginal repair, by other than attending ","code_information":[{"code":"59300","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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"ER PROC LEVEL 1 ","code_information":[{"code":"796659","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4221.00,"discounted_cash":4221.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":316.57,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":759.78,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1055.25,"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":928.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":506.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2110.50,"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":1021.48,"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":565.61,"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":451.65,"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":751.34,"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":1021.48,"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":751.34,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":590.94,"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":932.84,"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":839.98,"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":1139.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3587.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3165.75,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":548.73,"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":2110.50,"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":3376.80,"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":3587.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2110.50,"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":1202.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1899.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1067.91,"methodology":"percent of total billed charges"}]}]},{"description":"ER TRAUMA PROC LEVEL 1 ","code_information":[{"code":"595685","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4351.00,"discounted_cash":4351.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":326.32,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":783.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1087.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":957.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":522.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2175.50,"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":1052.94,"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":583.03,"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":465.56,"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":774.48,"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":1052.94,"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":774.48,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":609.14,"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":961.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":865.85,"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":1174.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3698.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3263.25,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":565.63,"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":2175.50,"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":3480.80,"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":3698.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2175.50,"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":1240.04,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1957.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1100.80,"methodology":"percent of total billed charges"}]}]},{"description":"ERH IMCU ADJ ","code_information":[{"code":"795187","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":8723.00,"discounted_cash":8723.00,"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":1439.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":654.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1666.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":1160.16,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1570.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2180.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2355.21,"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":2355.21,"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":2355.21,"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":2355.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1919.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1046.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4361.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2355.21,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2355.21,"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":2355.21,"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":2110.97,"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":1168.88,"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":933.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":462.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":427.43,"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":1552.69,"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":2110.97,"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":1552.69,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4361.50,"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":8723.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1221.22,"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":1927.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1735.88,"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":4361.50,"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":6978.40,"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":1395.68,"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":811.24,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":2006.29,"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":1831.83,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2965.82,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2006.29,"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":2355.21,"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":1657.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7414.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6542.25,"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":811.24,"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":1133.99,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4361.50,"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":6978.40,"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":7414.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4361.50,"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":1177.61,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":12648.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2486.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3925.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":2206.92,"methodology":"percent of total billed charges"}]}]},{"description":"ERLOTINIB 150 MG PO ","code_information":[{"code":"15771","type":"CDM"},{"code":"J8999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1170.00,"discounted_cash":1170.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":210.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":292.50,"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":315.90,"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":315.90,"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":315.90,"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":315.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":257.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":140.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":585.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":315.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":315.90,"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":315.90,"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":283.14,"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":156.78,"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":125.19,"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":208.26,"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":283.14,"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":208.26,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":585.00,"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":1170.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":163.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":258.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":232.83,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":585.00,"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":936.00,"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":187.20,"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":108.81,"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":269.10,"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":245.70,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":397.80,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":269.10,"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":315.90,"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":222.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":994.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":877.50,"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":108.81,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":152.10,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":585.00,"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":936.00,"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":994.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":585.00,"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":157.95,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1696.50,"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":333.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":526.50,"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":296.01,"methodology":"percent of total billed charges"}]}]},{"description":"Es sph augmnt device removal ","code_information":[{"code":"0393T","type":"CPT"},{"code":"490","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":"Es sph augmnt device removal ","code_information":[{"code":"0393T","type":"CPT"},{"code":"790","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":"Escharotomy; each additional incision (List separately in addition to code for primary procedure) ","code_information":[{"code":"16036","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Escharotomy; initial incision ","code_information":[{"code":"16035","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Escharotomy; initial incision ","code_information":[{"code":"16035","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"ESOMEPRAZOLE LIQ PO ","code_information":[{"code":"798609","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4.40,"discounted_cash":4.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":0.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":0.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":0.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":0.59,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.79,"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":1.10,"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":1.19,"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":1.19,"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":1.19,"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":1.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":0.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":0.53,"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":2.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1.19,"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":1.19,"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":1.06,"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":0.59,"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":0.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":0.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":0.22,"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":0.78,"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":1.06,"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":0.78,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.20,"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":4.40,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":0.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":0.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":0.88,"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":2.20,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3.52,"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":0.70,"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":0.41,"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":1.01,"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":0.92,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1.50,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1.01,"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":1.19,"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":0.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3.30,"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":0.41,"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":0.57,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3.52,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3.74,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2.20,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":0.59,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":6.38,"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":1.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1.98,"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":1.11,"methodology":"percent of total billed charges"}]}]},{"description":"ESOPH ENDO W/DILATION ","code_information":[{"code":"790663","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":756.00,"discounted_cash":756.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":56.70,"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":136.08,"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":204.12,"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":204.12,"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":204.12,"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":204.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":378.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":204.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":204.12,"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":204.12,"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":182.95,"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":101.30,"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":80.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":40.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":37.04,"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":134.57,"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":182.95,"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":134.57,"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":378.00,"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":756.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":105.84,"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":378.00,"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":604.80,"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":120.96,"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":70.31,"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":173.88,"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":173.88,"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":204.12,"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":143.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":642.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":567.00,"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":70.31,"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":378.00,"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":604.80,"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":642.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":378.00,"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":102.06,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1096.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":340.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":191.27,"methodology":"percent of total billed charges"}]}]},{"description":"Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; ","code_information":[{"code":"360","type":"RC"},{"code":"91037","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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; prolonged (greater than 1 hour, up to ","code_information":[{"code":"369","type":"RC"},{"code":"91038","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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; prolonged (greater than 1 hour, up to ","code_information":[{"code":"499","type":"RC"},{"code":"91038","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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion (eg, stimulant, acid or alkali perfusion) ( ","code_information":[{"code":"117360","type":"CDM"},{"code":"750","type":"RC"},{"code":"91013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"gross_charge":1539.00,"discounted_cash":1539.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple ","code_information":[{"code":"369","type":"RC"},{"code":"43239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method ","code_information":[{"code":"360","type":"RC"},{"code":"43255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease ","code_information":[{"code":"361","type":"RC"},{"code":"43257","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) ","code_information":[{"code":"43233","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie) ","code_information":[{"code":"369","type":"RC"},{"code":"43245","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie) ","code_information":[{"code":"43245","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie) ","code_information":[{"code":"43245","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube ","code_information":[{"code":"43246","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance ","code_information":[{"code":"369","type":"RC"},{"code":"43236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection ","code_information":[{"code":"369","type":"RC"},{"code":"43254","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures ","code_information":[{"code":"43237","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures ","code_information":[{"code":"43237","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is ","code_information":[{"code":"369","type":"RC"},{"code":"43259","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is ","code_information":[{"code":"43259","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed ","code_information":[{"code":"43210","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10567.00,"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":10567.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter ","code_information":[{"code":"360","type":"RC"},{"code":"43241","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps ","code_information":[{"code":"360","type":"RC"},{"code":"43250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) ","code_information":[{"code":"43249","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited t ","code_information":[{"code":"43238","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCOPY W/BAL DILA ","code_information":[{"code":"117264","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1727.00,"discounted_cash":1727.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":129.53,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":310.86,"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":466.29,"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":466.29,"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":466.29,"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":466.29,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":863.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":466.29,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":466.29,"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":466.29,"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":417.93,"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":231.42,"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":184.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":91.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":84.62,"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":307.41,"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":417.93,"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":307.41,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":863.50,"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":1727.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":241.78,"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":863.50,"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":1381.60,"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":276.32,"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":160.61,"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":397.21,"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":397.21,"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":466.29,"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":328.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1467.95,"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":1295.25,"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":160.61,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":863.50,"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":1381.60,"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":1467.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":863.50,"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":233.15,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2504.15,"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":777.15,"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":436.93,"methodology":"percent of total billed charges"}]}]},{"description":"Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"43200","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"369","type":"RC"},{"code":"43229","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with band ligation of esophageal varices ","code_information":[{"code":"43205","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with control of bleeding, any method ","code_information":[{"code":"43227","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with control of bleeding, any method ","code_information":[{"code":"43227","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) ","code_information":[{"code":"360","type":"RC"},{"code":"43214","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13320.00,"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":2580.00,"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":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) ","code_information":[{"code":"43214","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":13320.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) ","code_information":[{"code":"43214","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13320.00,"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":2580.00,"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":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed) ","code_information":[{"code":"360","type":"RC"},{"code":"43213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13320.00,"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":2580.00,"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":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed) ","code_information":[{"code":"43213","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":13320.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed) ","code_information":[{"code":"43213","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13320.00,"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":2580.00,"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":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance ","code_information":[{"code":"360","type":"RC"},{"code":"43201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with endoscopic mucosal resection ","code_information":[{"code":"43211","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13320.00,"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":2580.00,"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":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices ","code_information":[{"code":"369","type":"RC"},{"code":"43204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire ","code_information":[{"code":"43226","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire ","code_information":[{"code":"43226","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire ","code_information":[{"code":"43226","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with optical endomicroscopy ","code_information":[{"code":"361","type":"RC"},{"code":"43206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13320.00,"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":2580.00,"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":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"361","type":"RC"},{"code":"43212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13320.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case 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":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ","code_information":[{"code":"369","type":"RC"},{"code":"43217","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ","code_information":[{"code":"43217","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter) ","code_information":[{"code":"43220","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter) ","code_information":[{"code":"43220","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter) ","code_information":[{"code":"43220","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker's diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope ","code_information":[{"code":"43180","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker's diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope ","code_information":[{"code":"43180","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":6926.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"43191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter) ","code_information":[{"code":"360","type":"RC"},{"code":"43195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter) ","code_information":[{"code":"43195","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter) ","code_information":[{"code":"43195","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance ","code_information":[{"code":"369","type":"RC"},{"code":"43192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire ","code_information":[{"code":"361","type":"RC"},{"code":"43196","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"ESOPHAGOSCPY W/RM FB ","code_information":[{"code":"117334","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3378.00,"discounted_cash":3378.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":253.35,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":608.04,"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":912.06,"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":912.06,"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":912.06,"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":912.06,"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":1689.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":912.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":912.06,"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":912.06,"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":817.48,"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":452.65,"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":361.45,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":179.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":165.52,"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":601.28,"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":817.48,"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":601.28,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1689.00,"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":3378.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":472.92,"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":1689.00,"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":2702.40,"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":540.48,"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":314.15,"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":776.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":776.94,"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":912.06,"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":641.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2871.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2533.50,"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":314.15,"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":1689.00,"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":2702.40,"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":2871.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1689.00,"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":456.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":4898.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1520.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":854.63,"methodology":"percent of total billed charges"}]}]},{"description":"Esophagotomy, cervical approach, with removal of foreign body ","code_information":[{"code":"43020","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagotomy, cervical approach, with removal of foreign body ","code_information":[{"code":"43020","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Esophagus, acid perfusion (Bernstein) test for esophagitis ","code_information":[{"code":"369","type":"RC"},{"code":"91030","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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Esophagus, acid perfusion (Bernstein) test for esophagitis ","code_information":[{"code":"499","type":"RC"},{"code":"91030","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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation ","code_information":[{"code":"750","type":"RC"},{"code":"91035","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement, recording, analysis and interpretation ","code_information":[{"code":"369","type":"RC"},{"code":"91034","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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Esophagus, gastroesophageal reflux test; with nasal catheter pH electrode(s) placement, recording, analysis and interpretation ","code_information":[{"code":"499","type":"RC"},{"code":"91034","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"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Estrone ","code_information":[{"code":"82679","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.70,"maximum":52.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":26.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":26.45,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":37.42,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":26.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":31.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.70,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":24.70,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":24.70,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":24.84,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":24.95,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":42.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":29.69,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":26.20,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":26.20,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":52.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":52.40,"methodology":"fee schedule"}]}]},{"description":"Ethmoidectomy; extranasal, total ","code_information":[{"code":"31205","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Ethmoidectomy; intranasal, anterior ","code_information":[{"code":"31200","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Ethmoidectomy; intranasal, anterior ","code_information":[{"code":"31200","type":"CPT"},{"code":"790","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Ethmoidectomy; intranasal, total ","code_information":[{"code":"31201","type":"CPT"},{"code":"360","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":2580.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Ethmoidectomy; intranasal, total ","code_information":[{"code":"31201","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral ","code_information":[{"code":"0207T","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Evacuation of subungual hematoma ","code_information":[{"code":"11740","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Evacuation of subungual hematoma ","code_information":[{"code":"11740","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"EVAL PT HIGH COMPLEX ","code_information":[{"code":"792700","type":"CDM"},{"code":"97163","type":"CPT"}],"standard_charges":[{"modifiers":"GP","modifiers_description":"Services delivered under an outpatient physical therapy plan of care","setting":"outpatient","gross_charge":1480.00,"discounted_cash":1480.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":266.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":370.00,"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":399.60,"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":399.60,"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":399.60,"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":399.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":325.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":177.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":740.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":399.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":399.60,"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":399.60,"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":740.00,"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":1480.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":207.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":327.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":294.52,"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":740.00,"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":1184.00,"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":236.80,"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":137.64,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":340.40,"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":310.80,"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":503.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":340.40,"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":399.60,"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":281.20,"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":1258.00,"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":1110.00,"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":137.64,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":192.40,"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":740.00,"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":1184.00,"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":1258.00,"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":740.00,"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":199.80,"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":2146.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":421.80,"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":666.00,"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":374.44,"methodology":"percent of total billed charges"}]}]},{"description":"Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention ","code_information":[{"code":"750","type":"RC"},{"code":"93660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":21936.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16573.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21936.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":21400.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":6434.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Evisceration of ocular contents; with implant ","code_information":[{"code":"369","type":"RC"},{"code":"65093","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological ","code_information":[{"code":"369","type":"RC"},{"code":"50435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological ","code_information":[{"code":"499","type":"RC"},{"code":"50435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Exchange of intraocular lens ","code_information":[{"code":"360","type":"RC"},{"code":"66986","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate procedure) ","code_information":[{"code":"49423","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Exchange transfusion, blood; newborn ","code_information":[{"code":"36450","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangem ","code_information":[{"code":"499","type":"RC"},{"code":"67961","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision aural glomus tumor; transcanal ","code_information":[{"code":"369","type":"RC"},{"code":"69550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision aural glomus tumor; transcanal ","code_information":[{"code":"499","type":"RC"},{"code":"69550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision aural glomus tumor; transmastoid ","code_information":[{"code":"360","type":"RC"},{"code":"69552","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision aural glomus tumor; transmastoid ","code_information":[{"code":"490","type":"RC"},{"code":"69552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision aural glomus tumor; transmastoid ","code_information":[{"code":"69552","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues ","code_information":[{"code":"360","type":"RC"},{"code":"42810","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues ","code_information":[{"code":"42810","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision dermoid cyst, nose; complex, under bone or cartilage ","code_information":[{"code":"30125","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision dermoid cyst, nose; complex, under bone or cartilage ","code_information":[{"code":"30125","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision dermoid cyst, nose; simple, skin, subcutaneous ","code_information":[{"code":"30124","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision exostosis(es), external auditory canal ","code_information":[{"code":"369","type":"RC"},{"code":"69140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision exostosis(es), external auditory canal ","code_information":[{"code":"69140","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision external ear; complete amputation ","code_information":[{"code":"499","type":"RC"},{"code":"69120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision flexor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod ","code_information":[{"code":"26390","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision inferior turbinate, partial or complete, any method ","code_information":[{"code":"30130","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of Bartholin's gland or cyst ","code_information":[{"code":"361","type":"RC"},{"code":"56740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of Bartholin's gland or cyst ","code_information":[{"code":"481","type":"RC"},{"code":"56740","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesionºs») ","code_information":[{"code":"21046","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesionºs») ","code_information":[{"code":"21046","type":"CPT"},{"code":"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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision of bone (eg, for osteomyelitis or bone abscess); facial bone(s) ","code_information":[{"code":"21026","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of bone (eg, for osteomyelitis or bone abscess); mandible ","code_information":[{"code":"21025","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision of bone (eg, for osteomyelitis or bone abscess); mandible ","code_information":[{"code":"21025","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; deep (subfascial), includes autograft, when performed ","code_information":[{"code":"27066","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; superficial, includes autograft, when performed ","code_information":[{"code":"27065","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; superficial, includes autograft, when performed ","code_information":[{"code":"27065","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; with autograft requiring separate incision ","code_information":[{"code":"27067","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":7571.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion ","code_information":[{"code":"19125","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":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 rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of bulbourethral gland (Cowper's gland) ","code_information":[{"code":"360","type":"RC"},{"code":"53250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of bulbourethral gland (Cowper's gland) ","code_information":[{"code":"53250","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":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of cervical stump, vaginal approach; with anterior and/or posterior repair ","code_information":[{"code":"360","type":"RC"},{"code":"57555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision of cervical stump, vaginal approach; with anterior and/or posterior repair ","code_information":[{"code":"57555","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision of cervical stump, vaginal approach; with repair of enterocele ","code_information":[{"code":"57556","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision of chalazion; multiple, different lids ","code_information":[{"code":"499","type":"RC"},{"code":"67805","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Excision of chalazion; multiple, same lid ","code_information":[{"code":"481","type":"RC"},{"code":"67801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of chalazion; multiple, same lid ","code_information":[{"code":"67801","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of chalazion; single ","code_information":[{"code":"67800","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Excision of chalazion; under general anesthesia and/or requiring hospitalization, single or multiple ","code_information":[{"code":"499","type":"RC"},{"code":"67808","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"EXCISION OF CHEST WALL TUMOR INCLUDING RIBS ","code_information":[{"code":"19260","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":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":"EXCISION OF CHEST WALL TUMOR INCLUDING RIBS ","code_information":[{"code":"19260","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":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":"Excision of cyst or adenoma of thyroid, or transection of isthmus ","code_information":[{"code":"369","type":"RC"},{"code":"60200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Excision of cyst or adenoma of thyroid, or transection of isthmus ","code_information":[{"code":"499","type":"RC"},{"code":"60200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions ","code_information":[{"code":"19120","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":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 rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions ","code_information":[{"code":"19120","type":"CPT"},{"code":"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":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":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions ","code_information":[{"code":"19120","type":"CPT"},{"code":"790","type":"RC"}],"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 rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of cystic hygroma, axillary or cervical; with deep neurovascular dissection ","code_information":[{"code":"38555","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of cystic hygroma, axillary or cervical; without deep neurovascular dissection ","code_information":[{"code":"38550","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of extraparenchymal lesion of testis ","code_information":[{"code":"54512","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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of fibrous tuberosities, dentoalveolar structures ","code_information":[{"code":"360","type":"RC"},{"code":"41822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of ganglion, wrist (dorsal or volar); primary ","code_information":[{"code":"25111","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of ganglion, wrist (dorsal or volar); recurrent ","code_information":[{"code":"25112","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of hydrocele; unilateral ","code_information":[{"code":"499","type":"RC"},{"code":"55040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision of infected graft; extremity ","code_information":[{"code":"35903","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision of lacrimal gland (dacryoadenectomy), except for tumor; total ","code_information":[{"code":"369","type":"RC"},{"code":"68500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision of lacrimal gland (dacryoadenectomy), except for tumor; total ","code_information":[{"code":"499","type":"RC"},{"code":"68500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision of lacrimal gland tumor; involving osteotomy ","code_information":[{"code":"499","type":"RC"},{"code":"68550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision of lacrimal sac (dacryocystectomy) ","code_information":[{"code":"361","type":"RC"},{"code":"68520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Excision of lactiferous duct fistula ","code_information":[{"code":"19112","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lactiferous duct fistula ","code_information":[{"code":"19112","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure ","code_information":[{"code":"490","type":"RC"},{"code":"67840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee ","code_information":[{"code":"27347","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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee ","code_information":[{"code":"27347","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, with excision of underlying muscle ","code_information":[{"code":"40816","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, with excision of underlying muscle ","code_information":[{"code":"40816","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair ","code_information":[{"code":"40814","type":"CPT"},{"code":"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair ","code_information":[{"code":"40810","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of spermatic cord (separate procedure) ","code_information":[{"code":"55520","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankle ","code_information":[{"code":"27630","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue with closure; anterior two-thirds ","code_information":[{"code":"360","type":"RC"},{"code":"41112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue with closure; posterior one-third ","code_information":[{"code":"369","type":"RC"},{"code":"41113","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue with closure; with local tongue flap ","code_information":[{"code":"41114","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue without closure ","code_information":[{"code":"369","type":"RC"},{"code":"41110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion of tongue without closure ","code_information":[{"code":"41110","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion or tumor (except listed above), dentoalveolar structures; with simple repair ","code_information":[{"code":"361","type":"RC"},{"code":"41826","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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion or tumor (except listed above), dentoalveolar structures; with simple repair ","code_information":[{"code":"41826","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion or tumor (except listed above), dentoalveolar structures; without repair ","code_information":[{"code":"360","type":"RC"},{"code":"41825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion, conjunctiva; over 1 cm ","code_information":[{"code":"361","type":"RC"},{"code":"68115","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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion, conjunctiva; with adjacent sclera ","code_information":[{"code":"499","type":"RC"},{"code":"68130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium ","code_information":[{"code":"369","type":"RC"},{"code":"65400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot ","code_information":[{"code":"28090","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each ","code_information":[{"code":"28092","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each ","code_information":[{"code":"28092","type":"CPT"},{"code":"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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lingual frenum (frenectomy) ","code_information":[{"code":"360","type":"RC"},{"code":"41115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lingual frenum (frenectomy) ","code_information":[{"code":"41115","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lingual frenum (frenectomy) ","code_information":[{"code":"41115","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) ","code_information":[{"code":"40527","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6926.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of lip; V-excision with primary direct linear closure ","code_information":[{"code":"360","type":"RC"},{"code":"40520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of lip; V-excision with primary direct linear closure ","code_information":[{"code":"40520","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Excision of malignant tumor of maxilla or zygoma ","code_information":[{"code":"21034","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Excision of maxillary torus palatinus ","code_information":[{"code":"21032","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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Excision of mucosa of vestibule of mouth as donor graft ","code_information":[{"code":"360","type":"RC"},{"code":"40818","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Excision of mucosa of vestibule of mouth as donor graft ","code_information":[{"code":"40818","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Excision of multiple external papillae or tags, anus ","code_information":[{"code":"46230","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Open treatment of sesamoid fracture, with or without internal fixation ","code_information":[{"code":"28531","type":"CPT"},{"code":"369","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":7571.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Open treatment of sesamoid fracture, with or without internal fixation ","code_information":[{"code":"28531","type":"CPT"},{"code":"481","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":7571.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Open treatment of sesamoid fracture, with or without internal fixation ","code_information":[{"code":"28531","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":7571.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, includes internal fixation, when performed ","code_information":[{"code":"23670","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of slipped femoral epiphysis; closed manipulation with single or multiple pinning ","code_information":[{"code":"27178","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of sternoclavicular dislocation, acute or chronic; ","code_information":[{"code":"23530","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13545.00,"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":7571.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of talotarsal joint dislocation, includes internal fixation, when performed ","code_information":[{"code":"28585","type":"CPT"},{"code":"369","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":6926.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Open treatment of talus fracture, includes internal fixation, when performed ","code_information":[{"code":"28445","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13545.00,"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":6926.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed ","code_information":[{"code":"28615","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":13545.00,"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":7571.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed ","code_information":[{"code":"28615","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":13545.00,"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":7571.00,"methodology":"case 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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of temporomandibular dislocation ","code_information":[{"code":"21490","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":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":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Open treatment of temporomandibular dislocation ","code_information":[{"code":"21490","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":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed ","code_information":[{"code":"27535","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":11053.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed ","code_information":[{"code":"27535","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":11053.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed ","code_information":[{"code":"27535","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":11053.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage ","code_information":[{"code":"27758","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13545.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case 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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage ","code_information":[{"code":"27758","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage ","code_information":[{"code":"27758","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13545.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12056.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case 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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of trans-scaphoperilunar type of fracture dislocation ","code_information":[{"code":"25685","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lip ","code_information":[{"code":"27823","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"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":7571.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip ","code_information":[{"code":"27822","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":13545.00,"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":7571.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of ulnar shaft fracture, includes internal fixation, when performed ","code_information":[{"code":"25545","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":13545.00,"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":6926.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Open treatment of ulnar styloid fracture ","code_information":[{"code":"25652","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":13545.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; com ","code_information":[{"code":"360","type":"RC"},{"code":"92018","type":"CPT"}],"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":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Opponensplasty; hypothenar muscle transfer ","code_information":[{"code":"26494","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Opponensplasty; hypothenar muscle transfer ","code_information":[{"code":"26494","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Opponensplasty; other methods ","code_information":[{"code":"26496","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Opponensplasty; superficialis tendon transfer type, each tendon ","code_information":[{"code":"26490","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Opponensplasty; superficialis tendon transfer type, each tendon ","code_information":[{"code":"26490","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Opponensplasty; tendon transfer with graft (includes obtaining graft), each tendon ","code_information":[{"code":"26492","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Optic nerve decompression (eg, incision or fenestration of optic nerve sheath) ","code_information":[{"code":"67570","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbital implant (implant outside muscle cone); insertion ","code_information":[{"code":"369","type":"RC"},{"code":"67550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbital implant (implant outside muscle cone); removal or revision ","code_information":[{"code":"361","type":"RC"},{"code":"67560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbital implant (implant outside muscle cone); removal or revision ","code_information":[{"code":"481","type":"RC"},{"code":"67560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbital implant (implant outside muscle cone); removal or revision ","code_information":[{"code":"490","type":"RC"},{"code":"67560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach ","code_information":[{"code":"21267","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach ","code_information":[{"code":"21267","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); for exploration, with or without biopsy ","code_information":[{"code":"499","type":"RC"},{"code":"67450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with drainage ","code_information":[{"code":"361","type":"RC"},{"code":"67440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of bone for decompression ","code_information":[{"code":"360","type":"RC"},{"code":"67445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of foreign body ","code_information":[{"code":"481","type":"RC"},{"code":"67430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of foreign body ","code_information":[{"code":"490","type":"RC"},{"code":"67430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of lesion ","code_information":[{"code":"67420","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy ","code_information":[{"code":"369","type":"RC"},{"code":"67400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only ","code_information":[{"code":"361","type":"RC"},{"code":"67405","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with drainage only ","code_information":[{"code":"481","type":"RC"},{"code":"67405","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of bone for decompression ","code_information":[{"code":"369","type":"RC"},{"code":"67414","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of lesion ","code_information":[{"code":"499","type":"RC"},{"code":"67412","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Orchiectomy, partial ","code_information":[{"code":"361","type":"RC"},{"code":"54522","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Orchiectomy, partial ","code_information":[{"code":"481","type":"RC"},{"code":"54522","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Orchiectomy, partial ","code_information":[{"code":"490","type":"RC"},{"code":"54522","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Orchiectomy, radical, for tumor; inguinal approach ","code_information":[{"code":"361","type":"RC"},{"code":"54530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orchiectomy, radical, for tumor; inguinal approach ","code_information":[{"code":"481","type":"RC"},{"code":"54530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orchiectomy, radical, for tumor; with abdominal exploration ","code_information":[{"code":"369","type":"RC"},{"code":"54535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orchiectomy, radical, for tumor; with abdominal exploration ","code_information":[{"code":"490","type":"RC"},{"code":"54535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach ","code_information":[{"code":"54520","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orchiopexy, abdominal approach, for intra-abdominal testis (eg, Fowler-Stephens) ","code_information":[{"code":"490","type":"RC"},{"code":"54650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":10567.00,"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":10567.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Orchiopexy, inguinal or scrotal approach ","code_information":[{"code":"54640","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Organic acid, single, quantitative ","code_information":[{"code":"83921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21.00,"maximum":44.54,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":22.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":31.82,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":22.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":21.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.63,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":26.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.69,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":21.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":21.00,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":21.12,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":21.21,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":36.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.24,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":23.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":21.32,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":44.54,"methodology":"fee schedule"}]}]},{"description":"Ostectomy of scapula, partial (eg, superior medial angle) ","code_information":[{"code":"23190","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Ostectomy of sternum, partial ","code_information":[{"code":"21620","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":11053.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, calcaneus; ","code_information":[{"code":"28118","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, calcaneus; ","code_information":[{"code":"28118","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, calcaneus; for spur, with or without plantar fascial release ","code_information":[{"code":"28119","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, calcaneus; for spur, with or without plantar fascial release ","code_information":[{"code":"28119","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"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":"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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, complete excision; fifth metatarsal head ","code_information":[{"code":"28113","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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, complete excision; other metatarsal head (second, third or fourth) ","code_information":[{"code":"28112","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 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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, excision of tarsal coalition ","code_information":[{"code":"28116","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure) ","code_information":[{"code":"28110","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head ","code_information":[{"code":"28288","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograftºs») ","code_information":[{"code":"27416","type":"CPT"},{"code":"499","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":7571.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, carpal bone, shortening ","code_information":[{"code":"25394","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":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) ","code_information":[{"code":"21208","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, facial bones; reduction ","code_information":[{"code":"21209","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, humerus (eg, shortening or lengthening) (excluding 64876) ","code_information":[{"code":"24420","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, lengthening, metacarpal or phalanx ","code_information":[{"code":"26568","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":6926.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, lengthening, metacarpal or phalanx ","code_information":[{"code":"26568","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, lengthening, metacarpal or phalanx ","code_information":[{"code":"26568","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":6926.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Osteoplasty, radius OR ulna; shortening ","code_information":[{"code":"25390","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":7571.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"SC BX SOFT TISSUE NECK ","code_information":[{"code":"115589","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5830.00,"discounted_cash":5830.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":437.25,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1049.40,"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":1574.10,"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":1574.10,"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":1574.10,"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":1574.10,"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":2915.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1574.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1574.10,"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":1574.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":308.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":285.67,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2915.00,"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":5830.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":816.20,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2915.00,"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":4664.00,"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":932.80,"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":542.19,"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":1340.90,"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":1340.90,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1574.10,"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":1107.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4955.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4372.50,"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":542.19,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2915.00,"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":4664.00,"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":4955.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2915.00,"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":787.05,"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":8453.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2623.50,"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":1474.99,"methodology":"percent of total billed charges"}]}]},{"description":"SC BX TRANSCATH ","code_information":[{"code":"115952","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":18250.00,"discounted_cash":18250.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":1368.75,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3285.00,"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":4927.50,"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":4927.50,"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":4927.50,"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":4927.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9125.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":4927.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":4927.50,"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":4927.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":967.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":894.25,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9125.00,"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":18250.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":2555.00,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9125.00,"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":14600.00,"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":2920.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":1697.25,"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":4197.50,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":4197.50,"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":4927.50,"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":3467.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":15512.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13687.50,"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":1697.25,"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":9125.00,"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":14600.00,"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":15512.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":9125.00,"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":2463.75,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":26462.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8212.50,"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":4617.25,"methodology":"percent of total billed charges"}]}]},{"description":"Scapulopexy (eg, Sprengels deformity or for paralysis) ","code_information":[{"code":"23400","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":7571.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"SCISSORS LAPSCP MNPLR ","code_information":[{"code":"815068","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1297.00,"discounted_cash":1297.00,"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":214.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":97.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":247.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":172.50,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":233.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":324.25,"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":350.19,"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":350.19,"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":350.19,"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":350.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":285.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":155.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":648.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":350.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":350.19,"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":350.19,"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":313.87,"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":173.80,"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":138.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":68.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":63.55,"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":230.87,"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":313.87,"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":230.87,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":648.50,"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":1297.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":181.58,"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":286.64,"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":258.10,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":648.50,"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":1037.60,"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":207.52,"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":120.62,"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":298.31,"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":272.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":440.98,"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":298.31,"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":350.19,"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":246.43,"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":1102.45,"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":972.75,"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":120.62,"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":168.61,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":648.50,"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":1037.60,"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":1102.45,"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":648.50,"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":175.09,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1880.65,"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":369.64,"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":583.65,"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":328.14,"methodology":"percent of total billed charges"}]}]},{"description":"Scleral reinforcement (separate procedure); without graft ","code_information":[{"code":"361","type":"RC"},{"code":"67250","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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sclerotherapy of a fluid collection (eg, lymphocele, cyst, or seroma), percutaneous, including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance (eg, ultrasound, fluor ","code_information":[{"code":"481","type":"RC"},{"code":"49185","type":"CPT"}],"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":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Sclerotherapy of a fluid collection (eg, lymphocele, cyst, or seroma), percutaneous, including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance (eg, ultrasound, fluor ","code_information":[{"code":"490","type":"RC"},{"code":"49185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":4910.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Scraping of cornea, diagnostic, for smear and/or culture ","code_information":[{"code":"360","type":"RC"},{"code":"65430","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"SCREW BN 4.2MM 30MM ","code_information":[{"code":"889684","type":"CDM"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":352.00,"discounted_cash":352.00,"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":58.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":67.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":46.82,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":63.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":88.00,"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":95.04,"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":95.04,"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":95.04,"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":95.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":77.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":42.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":176.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":95.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":95.04,"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":95.04,"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":85.18,"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":47.17,"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":37.66,"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":62.66,"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":85.18,"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":62.66,"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":176.00,"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":352.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":49.28,"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":77.79,"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":70.05,"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":176.00,"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":281.60,"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":56.32,"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":32.74,"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":80.96,"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":73.92,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":119.68,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":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 total billed charges"}]}]},{"description":"SCREW EXFX 4X125MM ","code_information":[{"code":"895895","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SCREW EXFX 5X175MM ","code_information":[{"code":"893660","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SCREW EXFX 6X175X60MM ","code_information":[{"code":"817540","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":254.00,"discounted_cash":254.00,"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":41.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":19.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":48.51,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":33.78,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":45.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":63.50,"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":68.58,"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":68.58,"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":68.58,"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":68.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":55.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":30.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":127.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":68.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":68.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":68.58,"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":61.47,"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":34.04,"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":27.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":13.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":12.45,"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":45.21,"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":61.47,"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":45.21,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":127.00,"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":254.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":35.56,"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":56.13,"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":50.55,"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":127.00,"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":203.20,"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":40.64,"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":23.62,"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":58.42,"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":53.34,"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":86.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":58.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":68.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":48.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":215.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":190.50,"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":23.62,"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":33.02,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":127.00,"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":203.20,"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":215.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":127.00,"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":34.29,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":368.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":72.39,"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":114.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":64.26,"methodology":"percent of total billed charges"}]}]},{"description":"SCREW EXFX 80X4.5MM ","code_information":[{"code":"817567","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2261.00,"discounted_cash":2261.00,"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":373.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":169.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":431.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":300.71,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":406.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":565.25,"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":610.47,"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":610.47,"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":610.47,"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":610.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":497.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":271.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1130.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":610.47,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":610.47,"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":610.47,"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":547.16,"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":302.97,"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":241.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":119.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":110.79,"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":402.46,"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":547.16,"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":402.46,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1130.50,"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":2261.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":316.54,"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":499.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":449.94,"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":1130.50,"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":1808.80,"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":361.76,"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":210.27,"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":520.03,"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":474.81,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":768.74,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":520.03,"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":610.47,"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":429.59,"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":1921.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1695.75,"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":210.27,"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":293.93,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1130.50,"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":1808.80,"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":1921.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1130.50,"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":305.24,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3278.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":644.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1017.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":572.03,"methodology":"percent of total billed charges"}]}]},{"description":"Scrotal exploration ","code_information":[{"code":"55110","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":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"SEALANT FIBRN PREFL 10ML ","code_information":[{"code":"916603","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5110.00,"discounted_cash":5110.00,"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":843.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":383.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":976.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":679.63,"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":919.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1277.50,"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":1379.70,"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":1379.70,"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":1379.70,"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":1379.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1124.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":613.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2555.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1379.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1379.70,"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":1379.70,"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":1236.62,"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":684.74,"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":546.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":270.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":250.39,"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":909.58,"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":1236.62,"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":909.58,"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":2555.00,"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":5110.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":715.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1129.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1016.89,"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":2555.00,"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":4088.00,"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":817.60,"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":475.23,"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":1175.30,"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":1073.10,"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":1737.40,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1175.30,"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":1379.70,"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":970.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4343.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3832.50,"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":475.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":664.30,"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":2555.00,"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":4088.00,"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":4343.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2555.00,"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":689.85,"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":7409.50,"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":1456.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2299.50,"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":1292.83,"methodology":"percent of total billed charges"}]}]},{"description":"SEALANT PLR PROGL 4ML ","code_information":[{"code":"823990","type":"CDM"},{"code":"C2615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":6477.00,"discounted_cash":6477.00,"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":1068.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1237.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":861.44,"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":1165.86,"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":1619.25,"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":1748.79,"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":1748.79,"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":1748.79,"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":1748.79,"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":1424.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":777.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3238.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1748.79,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1748.79,"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":1748.79,"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":1567.43,"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":867.92,"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":693.04,"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":1152.91,"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":1567.43,"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":1152.91,"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":3238.50,"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":6477.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":906.78,"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":1431.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1288.92,"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":3238.50,"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":5181.60,"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":1036.32,"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":602.36,"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":1489.71,"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":1360.17,"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":2202.18,"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":1489.71,"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":1748.79,"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":1230.63,"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":5505.45,"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":4857.75,"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":602.36,"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":842.01,"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":3238.50,"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":5181.60,"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":5505.45,"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":3238.50,"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":874.39,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":9391.65,"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":1845.94,"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":2914.65,"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":1638.68,"methodology":"percent of total billed charges"}]}]},{"description":"SEALER BIP .137IN .226IN ","code_information":[{"code":"831110","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4304.00,"discounted_cash":4304.00,"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":710.16,"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":322.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":822.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":572.43,"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":774.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1076.00,"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":1162.08,"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":1162.08,"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":1162.08,"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":1162.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":946.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":516.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2152.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1162.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1162.08,"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":1162.08,"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":1041.57,"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":576.74,"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":460.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":228.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":210.90,"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":766.11,"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":1041.57,"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":766.11,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2152.00,"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":4304.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":602.56,"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":951.18,"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":856.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2152.00,"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":3443.20,"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":688.64,"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":400.27,"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":989.92,"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":903.84,"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":1463.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":989.92,"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":1162.08,"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":817.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3658.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3228.00,"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":400.27,"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":559.52,"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":2152.00,"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":3443.20,"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":3658.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2152.00,"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":581.04,"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":6240.80,"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":1226.64,"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":1936.80,"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":1088.91,"methodology":"percent of total billed charges"}]}]},{"description":"SEALER SYNCHROSEAL ","code_information":[{"code":"918426","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"Secondary closure of surgical wound or dehiscence, extensive or complicated ","code_information":[{"code":"13160","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast inje ","code_information":[{"code":"36251","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast inje ","code_information":[{"code":"36252","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast inje ","code_information":[{"code":"36252","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"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":"360","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"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":"36248","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family ","code_information":[{"code":"36215","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family ","code_information":[{"code":"36215","type":"CPT"},{"code":"490","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family ","code_information":[{"code":"36215","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"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":"36246","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family ","code_information":[{"code":"36216","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family ","code_information":[{"code":"36216","type":"CPT"},{"code":"490","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family ","code_information":[{"code":"36247","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family ","code_information":[{"code":"36217","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family ","code_information":[{"code":"36217","type":"CPT"},{"code":"490","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral extracranial carotid circulation and all associated radiological superv ","code_information":[{"code":"36222","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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 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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological superv ","code_information":[{"code":"36223","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":13545.00,"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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological superv ","code_information":[{"code":"36223","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":13545.00,"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 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":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"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":"36227","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, ","code_information":[{"code":"36224","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":13545.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13545.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13545.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, left or right pulmonary artery ","code_information":[{"code":"36014","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, inc ","code_information":[{"code":"36225","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, subclavian or innominate artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, inc ","code_information":[{"code":"36225","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9587.00,"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 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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) ","code_information":[{"code":"36011","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) ","code_information":[{"code":"36011","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Selective catheter placement, venous system; second order, or more selective, branch (eg, left adrenal vein, petrosal sinus) ","code_information":[{"code":"360","type":"RC"},{"code":"36012","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Semen analysis; volume, count, motility, and differential ","code_information":[{"code":"89320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.19,"maximum":25.85,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.68,"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":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Humana ","plan_name":"TRICR","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":12.31,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"NaphCare","plan_name":"Prison","standard_charge_dollar":20.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":25.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":25.85,"methodology":"fee schedule"}]}]},{"description":"SEMI-PVT RM W/ TELE ADJ ","code_information":[{"code":"596245","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4506.00,"discounted_cash":4506.00,"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":743.49,"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":337.95,"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":860.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":599.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":811.08,"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":1126.50,"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":1216.62,"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":1216.62,"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":1216.62,"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":1216.62,"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":991.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":540.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2253.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1216.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1216.62,"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":1216.62,"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":1090.45,"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":603.80,"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":482.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":238.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":220.79,"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":802.07,"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":1090.45,"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":802.07,"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":2253.00,"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":4506.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":630.84,"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":995.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":896.69,"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":2253.00,"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":3604.80,"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":720.96,"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":419.06,"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":1036.38,"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":946.26,"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":1532.04,"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":1036.38,"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":1216.62,"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":856.14,"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":3830.10,"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":3379.50,"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":419.06,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":585.78,"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":2253.00,"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":3604.80,"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":3830.10,"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":2253.00,"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":608.31,"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":6533.70,"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":1284.21,"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":2027.70,"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":1140.02,"methodology":"percent of total billed charges"}]}]},{"description":"SEMI-PVT RM W/ TELE ADJ ","code_information":[{"code":"790541","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4506.00,"discounted_cash":4506.00,"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":743.49,"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":337.95,"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":860.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":599.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":811.08,"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":1126.50,"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":1216.62,"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":1216.62,"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":1216.62,"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":1216.62,"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":991.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":540.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2253.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1216.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1216.62,"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":1216.62,"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":1090.45,"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":603.80,"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":482.14,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":238.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":220.79,"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":802.07,"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":1090.45,"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":802.07,"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":2253.00,"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":4506.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":630.84,"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":995.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":896.69,"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":2253.00,"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":3604.80,"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":720.96,"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":419.06,"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":1036.38,"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":946.26,"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":1532.04,"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":1036.38,"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":1216.62,"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":856.14,"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":3830.10,"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":3379.50,"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":419.06,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":585.78,"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":2253.00,"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":3604.80,"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":3830.10,"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":2253.00,"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":608.31,"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":6533.70,"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":1284.21,"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":2027.70,"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":1140.02,"methodology":"percent of total billed charges"}]}]},{"description":"SENSOR HEMODYNAMIC LARGE ","code_information":[{"code":"899664","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2932.00,"discounted_cash":2932.00,"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":483.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":219.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":560.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":389.96,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":527.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":733.00,"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":791.64,"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":791.64,"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":791.64,"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":791.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":645.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":351.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1466.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":791.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":791.64,"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":791.64,"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":709.54,"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":392.89,"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":313.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":155.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":143.67,"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":521.90,"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":709.54,"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":521.90,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1466.00,"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":2932.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":410.48,"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":647.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":583.47,"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":1466.00,"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":2345.60,"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":469.12,"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":272.68,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":674.36,"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":615.72,"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":996.88,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":674.36,"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":791.64,"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":557.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2492.20,"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":2199.00,"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":272.68,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":381.16,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1466.00,"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":2345.60,"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":2492.20,"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":1466.00,"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":395.82,"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":4251.40,"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":835.62,"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":1319.40,"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":741.80,"methodology":"percent of total billed charges"}]}]},{"description":"SEPTIC ARTHRITIS WITH CC ","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":418.00,"maximum":41051.73,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14107.35,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":14038.54,"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":11615.00,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":14176.17,"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":5080.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":13763.27,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":41051.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":26204.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21826.98,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":13900.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13900.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":29964.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":41051.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":29964.23,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10162.97,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":13763.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15139.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":16301.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":23179.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":13488.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14038.54,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":13763.27,"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":14038.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":15690.13,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":15414.86,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":13763.27,"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":13488.00,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":13488.00,"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":"Leon Health","plan_name":"MCR","standard_charge_dollar":13488.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14038.54,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"case rate"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":13763.27,"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":14589.07,"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":"NaphCare","plan_name":"Prison","standard_charge_dollar":28902.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17204.09,"methodology":"fee schedule"},{"payer_name":"Odyssey HealthCare","plan_name":"COMM","standard_charge_dollar":418.00,"methodology":"per diem"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8265.10,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":13763.27,"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":14313.80,"methodology":"fee schedule"},{"payer_name":"Seasons Hospice","plan_name":"COMM","standard_charge_dollar":850.00,"methodology":"per diem"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":26838.38,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":14451.43,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":104.00,"standard_charge_algorithm":"Reimbursement will be 104% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":15139.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13900.90,"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":10400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7822 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":13763.27,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":13116.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7822 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":13763.27,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":13763.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13350.37,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":26838.38,"methodology":"fee schedule"}]}]},{"description":"Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft ","code_information":[{"code":"30520","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft ","code_information":[{"code":"30520","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), clavicle ","code_information":[{"code":"23170","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist ","code_information":[{"code":"25145","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck ","code_information":[{"code":"23174","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck ","code_information":[{"code":"23174","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck ","code_information":[{"code":"24136","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus ","code_information":[{"code":"24134","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":7571.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Sesamoidectomy, first toe (separate procedure) ","code_information":[{"code":"28315","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sesamoidectomy, thumb or finger (separate procedure) ","code_information":[{"code":"26185","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"SET ACC MNPNCH 4FR 10CM ","code_information":[{"code":"866864","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1184.00,"discounted_cash":1184.00,"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":195.36,"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":88.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":226.14,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":157.47,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":213.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":296.00,"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":319.68,"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":319.68,"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":319.68,"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":319.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":260.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":142.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":319.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":319.68,"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":319.68,"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":286.53,"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":158.66,"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":126.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":62.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":58.02,"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":210.75,"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":286.53,"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":210.75,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.00,"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":1184.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":165.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":261.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":235.62,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.00,"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":947.20,"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":189.44,"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":110.11,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":272.32,"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":248.64,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":402.56,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":272.32,"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":319.68,"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":224.96,"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":1006.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":888.00,"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":110.11,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":153.92,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.00,"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":947.20,"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":1006.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":592.00,"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":159.84,"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":1716.80,"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":337.44,"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":532.80,"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":299.55,"methodology":"percent of total billed charges"}]}]},{"description":"SET ADM 124IN 60 GTT 13. ","code_information":[{"code":"833920","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":447.00,"discounted_cash":447.00,"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":73.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":33.52,"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":85.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":59.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":80.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":111.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":120.69,"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":120.69,"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":120.69,"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":120.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":98.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":53.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":223.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":120.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":120.69,"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":120.69,"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":108.17,"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":59.90,"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":47.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":23.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":21.90,"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":79.57,"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":108.17,"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":79.57,"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":223.50,"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":447.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":62.58,"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":98.79,"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":88.95,"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":223.50,"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":357.60,"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":71.52,"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":41.57,"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":102.81,"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":93.87,"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":151.98,"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":102.81,"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":120.69,"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":84.93,"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":379.95,"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":335.25,"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":41.57,"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":58.11,"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":223.50,"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":357.60,"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":379.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":223.50,"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":60.34,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":648.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":127.39,"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":201.15,"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":113.09,"methodology":"percent of total billed charges"}]}]},{"description":"SET ADM PLMS NDEHP 104IN ","code_information":[{"code":"851633","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":306.00,"discounted_cash":306.00,"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":50.49,"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":22.95,"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":58.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":40.70,"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":55.08,"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":76.50,"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":82.62,"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":82.62,"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":82.62,"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":82.62,"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":67.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":36.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":153.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":82.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":82.62,"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":82.62,"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":74.05,"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":41.00,"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":32.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":16.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":14.99,"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":54.47,"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":74.05,"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":54.47,"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":153.00,"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":306.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":42.84,"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":67.63,"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":60.89,"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":153.00,"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":244.80,"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":48.96,"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":28.46,"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":70.38,"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":64.26,"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":104.04,"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":70.38,"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":82.62,"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":58.14,"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":260.10,"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":229.50,"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":28.46,"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":39.78,"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":153.00,"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":244.80,"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":260.10,"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":153.00,"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":41.31,"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":443.70,"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":87.21,"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":137.70,"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":77.42,"methodology":"percent of total billed charges"}]}]},{"description":"SET CATH ENDO .035IN ","code_information":[{"code":"863917","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":6403.00,"discounted_cash":6403.00,"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":1056.49,"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":480.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1222.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":851.60,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1152.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1600.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1728.81,"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":1728.81,"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":1728.81,"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":1728.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1408.66,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":768.36,"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":3201.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1728.81,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1728.81,"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":1728.81,"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":1549.53,"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":858.00,"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":685.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":339.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":313.75,"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":1139.73,"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":1549.53,"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":1139.73,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3201.50,"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":6403.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":896.42,"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":1415.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1274.20,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3201.50,"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":5122.40,"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":1024.48,"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":595.48,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1472.69,"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":1344.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2177.02,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1472.69,"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":1728.81,"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":1216.57,"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":5442.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4802.25,"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":595.48,"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":832.39,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3201.50,"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":5122.40,"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":5442.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3201.50,"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":864.40,"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":9284.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1824.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2881.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1619.96,"methodology":"percent of total billed charges"}]}]},{"description":"SET CTH CV7F 3LM 25G15CM ","code_information":[{"code":"892441","type":"CDM"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SET DILATOR STIM ","code_information":[{"code":"849144","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4990.00,"discounted_cash":4990.00,"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":823.35,"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":374.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":953.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":663.67,"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":898.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1247.50,"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":1347.30,"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":1347.30,"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":1347.30,"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":1347.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1097.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":598.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2495.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1347.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1347.30,"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":1347.30,"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":1207.58,"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":668.66,"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":533.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":264.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":244.51,"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":888.22,"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":1207.58,"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":888.22,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2495.00,"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":4990.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":698.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1102.79,"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":993.01,"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":2495.00,"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":3992.00,"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":798.40,"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":464.07,"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":1147.70,"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":1047.90,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1696.60,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1147.70,"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":1347.30,"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":948.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4241.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3742.50,"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":464.07,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":648.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2495.00,"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":3992.00,"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":4241.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2495.00,"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":673.65,"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":7235.50,"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":1422.15,"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":2245.50,"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":1262.47,"methodology":"percent of total billed charges"}]}]},{"description":"SET ENDO INST DART ","code_information":[{"code":"804007","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"SET EXT TRPL MAC LF 6IN ","code_information":[{"code":"801791","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":120.00,"discounted_cash":120.00,"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":19.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":9.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":22.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":15.96,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":21.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":30.00,"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":32.40,"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":32.40,"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":32.40,"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":32.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":26.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":14.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":32.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":32.40,"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":32.40,"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":29.04,"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":16.08,"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":12.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":6.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.88,"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":21.36,"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":29.04,"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":21.36,"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":60.00,"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":120.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":16.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":26.52,"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":23.88,"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":60.00,"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":96.00,"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":19.20,"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":11.16,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":27.60,"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":25.20,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":40.80,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":27.60,"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":32.40,"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":22.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":102.00,"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":90.00,"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":11.16,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":15.60,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":60.00,"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":96.00,"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":102.00,"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":60.00,"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":16.20,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":174.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":34.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":54.00,"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":30.36,"methodology":"percent of total billed charges"}]}]},{"description":"SET EXTENSION 2C6671 ","code_information":[{"code":"885927","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":146.00,"discounted_cash":146.00,"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":24.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":10.95,"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":27.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":19.42,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":26.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":36.50,"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":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":32.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":17.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":73.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":39.42,"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":35.33,"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":19.56,"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":15.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":7.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":7.15,"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":25.99,"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":35.33,"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":25.99,"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":73.00,"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":146.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":20.44,"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":32.27,"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":29.05,"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":73.00,"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":116.80,"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":23.36,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":13.58,"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":33.58,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":30.66,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":49.64,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":33.58,"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":39.42,"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":27.74,"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":124.10,"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":109.50,"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":13.58,"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":18.98,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":73.00,"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":116.80,"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":124.10,"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":73.00,"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":19.71,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":211.70,"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":41.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":65.70,"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":36.94,"methodology":"percent of total billed charges"}]}]},{"description":"SET GSTRM 20FR 4.47MM ","code_information":[{"code":"921864","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SET INTERLINK Y TYPE EXT ","code_information":[{"code":"806439","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":105.00,"discounted_cash":105.00,"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":17.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":7.88,"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":20.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":13.96,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":18.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":26.25,"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":28.35,"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":28.35,"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":28.35,"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":28.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":23.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":12.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":52.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":28.35,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":28.35,"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":28.35,"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":25.41,"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":14.07,"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":11.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":5.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":5.14,"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":18.69,"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":25.41,"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":18.69,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":52.50,"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":105.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":14.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":23.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":20.89,"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":52.50,"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":84.00,"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":16.80,"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":9.77,"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":24.15,"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":22.05,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":35.70,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":24.15,"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":28.35,"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":19.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":89.25,"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":78.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":9.77,"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":13.65,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":52.50,"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":84.00,"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":89.25,"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":52.50,"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":14.18,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":152.25,"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":29.93,"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":47.25,"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":26.57,"methodology":"percent of total billed charges"}]}]},{"description":"SET IV EXTN 7IN .3ML ","code_information":[{"code":"806484","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":32.00,"discounted_cash":32.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":5.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":6.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":4.26,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.76,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":8.00,"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":8.64,"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":8.64,"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":8.64,"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":8.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":7.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":8.64,"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":8.64,"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":7.74,"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":4.29,"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":3.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.57,"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":5.70,"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":7.74,"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":5.70,"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":16.00,"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":32.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":4.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":6.37,"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":16.00,"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":25.60,"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":5.12,"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":2.98,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":7.36,"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":6.72,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":10.88,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":7.36,"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":8.64,"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":6.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":27.20,"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":24.00,"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":2.98,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":4.16,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":16.00,"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":25.60,"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":27.20,"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":16.00,"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":4.32,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":46.40,"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":9.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":14.40,"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":8.10,"methodology":"percent of total billed charges"}]}]},{"description":"SET IV PRES 7IN 0.31ML ","code_information":[{"code":"889309","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38.00,"discounted_cash":38.00,"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":6.27,"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":2.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":7.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":5.05,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":9.50,"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":10.26,"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":10.26,"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":10.26,"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":10.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":8.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":4.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":10.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":10.26,"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":10.26,"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":9.20,"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":5.09,"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":4.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.86,"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":6.76,"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":9.20,"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":6.76,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.00,"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":38.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":5.32,"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":8.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":7.56,"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":19.00,"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":30.40,"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":6.08,"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":3.53,"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":8.74,"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":7.98,"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":12.92,"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":8.74,"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":10.26,"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":7.22,"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":32.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":28.50,"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":3.53,"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":4.94,"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":19.00,"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":30.40,"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":32.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":19.00,"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":5.13,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":55.10,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":10.83,"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":17.10,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":9.61,"methodology":"percent of total billed charges"}]}]},{"description":"SET TUBING Y CONN STRL ","code_information":[{"code":"834064","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":366.00,"discounted_cash":366.00,"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":60.39,"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":27.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":69.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":48.68,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":65.88,"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":91.50,"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":98.82,"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":98.82,"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":98.82,"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":98.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":80.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":43.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":183.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":98.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":98.82,"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":98.82,"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":88.57,"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":49.04,"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":39.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":19.40,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":17.93,"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":65.15,"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":88.57,"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":65.15,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":183.00,"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":366.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":51.24,"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":80.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":72.83,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":183.00,"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":292.80,"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":58.56,"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":34.04,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":84.18,"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":76.86,"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":124.44,"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":84.18,"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":98.82,"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":69.54,"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":311.10,"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":274.50,"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":34.04,"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":47.58,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":183.00,"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":292.80,"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":311.10,"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":183.00,"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":49.41,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":530.70,"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":104.31,"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":164.70,"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":92.60,"methodology":"percent of total billed charges"}]}]},{"description":"SET XTN ORNG 60IN NUTRIO ","code_information":[{"code":"908707","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":29.00,"discounted_cash":29.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":4.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":2.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":5.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":3.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":7.25,"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":7.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":3.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7.83,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7.83,"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":7.02,"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":3.89,"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":3.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":1.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":1.42,"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":5.16,"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":7.02,"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":5.16,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14.50,"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":29.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":4.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":6.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":5.77,"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":14.50,"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":23.20,"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":4.64,"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":2.70,"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":6.67,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":6.09,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":9.86,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":6.67,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":7.83,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":5.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":24.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":21.75,"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":2.70,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":3.77,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14.50,"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":23.20,"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":24.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":14.50,"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":3.92,"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":42.05,"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":8.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13.05,"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":7.34,"methodology":"percent of total billed charges"}]}]},{"description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); anterior synechiae, except goniosynechiae ","code_information":[{"code":"65870","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); corneovitreal adhesions ","code_information":[{"code":"499","type":"RC"},{"code":"65880","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":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae ","code_information":[{"code":"499","type":"RC"},{"code":"65875","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Severing adhesions of anterior segment, laser technique (separate procedure) ","code_information":[{"code":"361","type":"RC"},{"code":"65860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Severing adhesions of anterior segment, laser technique (separate procedure) ","code_information":[{"code":"65860","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (1 or more stages) ","code_information":[{"code":"361","type":"RC"},{"code":"67031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":4678.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm ","code_information":[{"code":"11311","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"11312","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm ","code_information":[{"code":"11313","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less ","code_information":[{"code":"11305","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less ","code_information":[{"code":"11305","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm ","code_information":[{"code":"11308","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less ","code_information":[{"code":"11300","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less ","code_information":[{"code":"11300","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less ","code_information":[{"code":"11300","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm ","code_information":[{"code":"11301","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"11302","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"SHEAR DVNC XI 26.84CMX8M ","code_information":[{"code":"886683","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"SHEARS ESURG DISP 8MM ","code_information":[{"code":"828318","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5365.00,"discounted_cash":5365.00,"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":885.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":402.38,"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":1024.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":713.54,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":965.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1341.25,"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":1448.55,"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":1448.55,"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":1448.55,"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":1448.55,"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":1180.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":643.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2682.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1448.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1448.55,"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":1448.55,"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":1298.33,"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":718.91,"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":574.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":284.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":262.89,"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":954.97,"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":1298.33,"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":954.97,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2682.50,"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":5365.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":751.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1185.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1067.63,"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":2682.50,"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":4292.00,"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":858.40,"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":498.95,"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":1233.95,"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":1126.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1824.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1233.95,"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":1448.55,"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":1019.35,"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":4560.25,"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":4023.75,"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":498.95,"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":697.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2682.50,"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":4292.00,"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":4560.25,"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":2682.50,"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":724.27,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7779.25,"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":1529.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2414.25,"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":1357.35,"methodology":"percent of total billed charges"}]}]},{"description":"SHEARS LAPSCP 5MM 36CM ","code_information":[{"code":"943761","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5365.00,"discounted_cash":5365.00,"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":885.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":402.38,"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":1024.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":713.54,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":965.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1341.25,"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":1448.55,"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":1448.55,"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":1448.55,"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":1448.55,"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":1180.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":643.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2682.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1448.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1448.55,"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":1448.55,"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":1298.33,"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":718.91,"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":574.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":284.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":262.89,"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":954.97,"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":1298.33,"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":954.97,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2682.50,"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":5365.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":751.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1185.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1067.63,"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":2682.50,"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":4292.00,"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":858.40,"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":498.95,"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":1233.95,"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":1126.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1824.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1233.95,"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":1448.55,"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":1019.35,"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":4560.25,"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":4023.75,"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":498.95,"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":697.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2682.50,"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":4292.00,"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":4560.25,"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":2682.50,"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":724.27,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7779.25,"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":1529.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2414.25,"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":1357.35,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH 6FR STR LNG 80CM ","code_information":[{"code":"944870","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH CLOTREM 16FR ","code_information":[{"code":"929878","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":8882.00,"discounted_cash":8882.00,"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":1465.53,"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":666.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1696.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":1181.31,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1598.76,"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":2220.50,"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":2398.14,"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":2398.14,"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":2398.14,"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":2398.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1954.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1065.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4441.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2398.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2398.14,"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":2398.14,"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":2149.44,"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":1190.19,"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":950.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":470.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":435.22,"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":1581.00,"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":2149.44,"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":1581.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4441.00,"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":8882.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1243.48,"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":1962.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1767.52,"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":4441.00,"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":7105.60,"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":1421.12,"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":826.03,"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":2042.86,"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":1865.22,"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":3019.88,"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":2042.86,"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":2398.14,"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":1687.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7549.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6661.50,"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":826.03,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1154.66,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4441.00,"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":7105.60,"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":7549.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4441.00,"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":1199.07,"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":12878.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2531.37,"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":3996.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":2247.15,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH DIL TGHTRL MN 9F ","code_information":[{"code":"880341","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":11066.00,"discounted_cash":11066.00,"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":1825.89,"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":2113.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":1471.78,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1991.88,"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":2766.50,"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":2987.82,"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":2987.82,"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":2987.82,"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":2987.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":2434.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1327.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5533.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2987.82,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2987.82,"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":2987.82,"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":2677.97,"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":1482.84,"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":1184.06,"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":1969.75,"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":2677.97,"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":1969.75,"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":5533.00,"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":11066.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1549.24,"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":2445.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":2202.13,"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":5533.00,"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":8852.80,"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":1770.56,"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":1029.14,"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":2545.18,"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":2323.86,"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":3762.44,"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":2545.18,"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":2987.82,"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":2102.54,"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":9406.10,"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":8299.50,"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":1029.14,"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":1438.58,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":5533.00,"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":8852.80,"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":9406.10,"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":5533.00,"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":1493.91,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":16045.70,"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":3153.81,"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":4979.70,"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":2799.70,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH ESURG 9FR ","code_information":[{"code":"864421","type":"CDM"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":4454.00,"discounted_cash":4454.00,"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":734.91,"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":850.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":592.38,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":801.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1113.50,"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":1202.58,"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":1202.58,"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":1202.58,"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":1202.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":979.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":534.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2227.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1202.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1202.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1202.58,"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":1077.87,"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":596.84,"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":476.58,"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":792.81,"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":1077.87,"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":792.81,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2227.00,"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":4454.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":623.56,"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":984.33,"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":886.35,"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":2227.00,"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":3563.20,"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":712.64,"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":414.22,"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":1024.42,"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":935.34,"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":1514.36,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1024.42,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1202.58,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":846.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3785.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3340.50,"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":414.22,"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":579.02,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2227.00,"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":3563.20,"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":3785.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2227.00,"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":601.29,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":6458.30,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1269.39,"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":2004.30,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1126.86,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH GD 11FR 25CM ","code_information":[{"code":"809133","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":711.00,"discounted_cash":711.00,"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":117.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":135.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":94.56,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":127.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":177.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":191.97,"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":191.97,"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":191.97,"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":191.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":156.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":85.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":355.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":191.97,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":191.97,"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":191.97,"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":172.06,"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":95.27,"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":76.08,"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":126.56,"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":172.06,"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":126.56,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":355.50,"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":711.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":99.54,"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":157.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":141.49,"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":355.50,"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":568.80,"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":113.76,"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":66.12,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":163.53,"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":149.31,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":241.74,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":163.53,"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":191.97,"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":135.09,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":604.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":533.25,"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":66.12,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":92.43,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":355.50,"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":568.80,"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":604.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":355.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":95.98,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1030.95,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":202.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":319.95,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":179.88,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH GD 8FR 70CM ","code_information":[{"code":"934345","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1687.00,"discounted_cash":1687.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":278.36,"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":322.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":224.37,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":303.66,"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":421.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":455.49,"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":455.49,"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":455.49,"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":455.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":371.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":202.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":843.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":455.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":455.49,"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":455.49,"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":408.25,"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":226.06,"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":180.51,"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":300.29,"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":408.25,"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":300.29,"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":843.50,"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":1687.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":236.18,"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":372.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":335.71,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":843.50,"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":1349.60,"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":269.92,"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":156.89,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":388.01,"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":354.27,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":573.58,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":388.01,"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":455.49,"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":320.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1433.95,"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":1265.25,"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":156.89,"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":219.31,"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":843.50,"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":1349.60,"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":1433.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":843.50,"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":227.75,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2446.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":480.80,"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":759.15,"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":426.81,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO 20FR 65CM ","code_information":[{"code":"920148","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"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":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO 28CM 18FR ","code_information":[{"code":"861702","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":3680.00,"discounted_cash":3680.00,"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":607.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":702.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":489.44,"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":662.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":920.00,"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":993.60,"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":993.60,"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":993.60,"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":993.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":809.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":441.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1840.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":993.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":993.60,"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":993.60,"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":890.56,"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":493.12,"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":393.76,"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":655.04,"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":890.56,"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":655.04,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1840.00,"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":3680.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":515.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":813.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":732.32,"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":1840.00,"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":2944.00,"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":588.80,"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":342.24,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":846.40,"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":772.80,"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":1251.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":846.40,"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":993.60,"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":699.20,"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":3128.00,"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":2760.00,"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":342.24,"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":478.40,"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":1840.00,"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":2944.00,"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":3128.00,"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":1840.00,"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":496.80,"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":5336.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1048.80,"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":1656.00,"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":931.04,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO 5F 23CM ","code_information":[{"code":"813640","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":664.00,"discounted_cash":664.00,"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":109.56,"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":126.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":88.31,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":119.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":166.00,"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":179.28,"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":179.28,"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":179.28,"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":179.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":146.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":79.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":332.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":179.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":179.28,"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":179.28,"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":160.69,"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":88.98,"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":71.05,"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":118.19,"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":160.69,"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":118.19,"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":332.00,"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":664.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":92.96,"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":146.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":132.14,"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":332.00,"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":531.20,"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":106.24,"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":61.75,"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":152.72,"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":139.44,"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":225.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":152.72,"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":179.28,"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":126.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":564.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":498.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":61.75,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":86.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":332.00,"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":531.20,"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":564.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":332.00,"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":89.64,"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":962.80,"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":189.24,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":298.80,"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":167.99,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO 6F 25CM ","code_information":[{"code":"809129","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":616.00,"discounted_cash":616.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":101.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":117.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":81.93,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":110.88,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":154.00,"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":166.32,"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":166.32,"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":166.32,"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":166.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":135.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":73.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":166.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":166.32,"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":166.32,"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":149.07,"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":82.54,"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":65.91,"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":109.65,"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":149.07,"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":109.65,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.00,"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":616.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":86.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":136.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":122.58,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.00,"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":492.80,"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":98.56,"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":57.29,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":141.68,"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":129.36,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":209.44,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":141.68,"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":166.32,"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":117.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":523.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":462.00,"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":57.29,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":80.08,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.00,"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":492.80,"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":523.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":308.00,"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":83.16,"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":893.20,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":175.56,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":277.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":155.85,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO 7FR 25CM ","code_information":[{"code":"809130","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":826.00,"discounted_cash":826.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":136.29,"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":157.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":109.86,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":148.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":206.50,"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":223.02,"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":223.02,"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":223.02,"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":223.02,"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":181.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":99.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":413.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":223.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":223.02,"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":223.02,"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":199.89,"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":110.68,"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":88.38,"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":147.03,"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":199.89,"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":147.03,"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":413.00,"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":826.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":115.64,"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":182.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":164.37,"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":413.00,"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":660.80,"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":132.16,"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":76.82,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":189.98,"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":173.46,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":280.84,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":189.98,"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":223.02,"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":156.94,"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":702.10,"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":619.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":76.82,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":107.38,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":413.00,"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":660.80,"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":702.10,"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":413.00,"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":111.51,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1197.70,"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":235.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":371.70,"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":208.98,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO 7FR 65CM ","code_information":[{"code":"800308","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO GW 11F 11CM ","code_information":[{"code":"813658","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":282.00,"discounted_cash":282.00,"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":46.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":53.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":37.51,"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":50.76,"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":70.50,"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":76.14,"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":76.14,"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":76.14,"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":76.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":62.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":33.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":76.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":76.14,"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":76.14,"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":68.24,"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":37.79,"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":30.17,"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":50.20,"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":68.24,"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":50.20,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"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":282.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":39.48,"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":62.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":56.12,"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":141.00,"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":225.60,"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":45.12,"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":26.23,"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":64.86,"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":59.22,"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":95.88,"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":64.86,"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":76.14,"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":53.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":239.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":211.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":26.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":36.66,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"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":225.60,"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":239.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":38.07,"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":408.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":80.37,"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":126.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":71.35,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH INTRO GW 7F 11CM ","code_information":[{"code":"813647","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":282.00,"discounted_cash":282.00,"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":46.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":53.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":37.51,"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":50.76,"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":70.50,"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":76.14,"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":76.14,"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":76.14,"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":76.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":62.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":33.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":76.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":76.14,"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":76.14,"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":68.24,"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":37.79,"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":30.17,"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":50.20,"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":68.24,"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":50.20,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"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":282.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":39.48,"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":62.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":56.12,"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":141.00,"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":225.60,"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":45.12,"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":26.23,"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":64.86,"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":59.22,"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":95.88,"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":64.86,"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":76.14,"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":53.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":239.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":211.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":26.23,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":36.66,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"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":225.60,"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":239.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":141.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":38.07,"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":408.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":80.37,"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":126.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":71.35,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH LD TORQMAX GRP ","code_information":[{"code":"880342","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SHEATH STRBL 10FR 13MM ","code_information":[{"code":"946837","type":"CDM"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":8883.00,"discounted_cash":8883.00,"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":1465.69,"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":1696.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":1181.44,"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":1598.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":2220.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2398.41,"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":2398.41,"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":2398.41,"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":2398.41,"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":1954.26,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1065.96,"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":4441.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2398.41,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":2398.41,"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":2398.41,"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":2149.69,"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":1190.32,"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":950.48,"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":1581.17,"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":2149.69,"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":1581.17,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4441.50,"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":8883.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1243.62,"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":1963.14,"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":1767.72,"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":4441.50,"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":7106.40,"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":1421.28,"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":826.12,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":2043.09,"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":1865.43,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":3020.22,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":2043.09,"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":2398.41,"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":1687.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7550.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6662.25,"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":826.12,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":1154.79,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4441.50,"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":7106.40,"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":7550.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":4441.50,"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":1199.20,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":12880.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":2531.66,"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":3997.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":2247.40,"methodology":"percent of total billed charges"}]}]},{"description":"SHEETING SIL 30.5X43.2 ","code_information":[{"code":"893063","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"Shortening of tendon, extensor, hand or finger, each tendon ","code_information":[{"code":"26477","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Shortening of tendon, flexor, hand or finger, each tendon ","code_information":[{"code":"26479","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"SHRT LATENCY SOMA UP LMB ","code_information":[{"code":"121863","type":"CDM"},{"code":"95925","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":2082.00,"discounted_cash":2082.00,"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":343.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":397.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":276.91,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":374.76,"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":520.50,"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":562.14,"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":562.14,"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":562.14,"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":562.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":458.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":249.84,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1041.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":562.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":562.14,"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":562.14,"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":503.84,"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":278.99,"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":222.77,"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":370.60,"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":503.84,"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":370.60,"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":1041.00,"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":2082.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":291.48,"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":460.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":414.32,"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":1041.00,"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":1665.60,"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":333.12,"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":193.63,"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":478.86,"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":437.22,"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":707.88,"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":478.86,"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":562.14,"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":395.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1769.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1561.50,"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":193.63,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":270.66,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1041.00,"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":1665.60,"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":1769.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1041.00,"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":281.07,"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":3018.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":593.37,"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":936.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":526.75,"methodology":"percent of total billed charges"}]}]},{"description":"SHTH MPNCH 4.0 10CM ","code_information":[{"code":"843762","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1859.00,"discounted_cash":1859.00,"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":306.74,"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":355.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":247.25,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":334.62,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":464.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":501.93,"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":501.93,"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":501.93,"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":501.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":408.98,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":223.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":929.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":501.93,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":501.93,"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":501.93,"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":449.88,"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":249.11,"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":198.91,"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":330.90,"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":449.88,"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":330.90,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":929.50,"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":1859.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":260.26,"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":410.84,"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":369.94,"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":929.50,"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":1487.20,"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":297.44,"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":172.89,"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":427.57,"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":390.39,"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":632.06,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":427.57,"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":501.93,"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":353.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1580.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1394.25,"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":172.89,"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":241.67,"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":929.50,"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":1487.20,"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":1580.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":929.50,"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":250.97,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2695.55,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":529.82,"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":836.55,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":470.33,"methodology":"percent of total billed charges"}]}]},{"description":"SHUNT CAROTD XTRN 3X5MM ","code_information":[{"code":"806044","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5527.00,"discounted_cash":5527.00,"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":911.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":414.52,"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":1055.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":735.09,"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":994.86,"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":1381.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1492.29,"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":1492.29,"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":1492.29,"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":1492.29,"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":1215.94,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":663.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2763.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1492.29,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1492.29,"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":1492.29,"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":1337.53,"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":740.62,"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":591.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":292.93,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":270.82,"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":983.81,"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":1337.53,"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":983.81,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2763.50,"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":5527.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":773.78,"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":1221.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1099.87,"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":2763.50,"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":4421.60,"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":884.32,"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":514.01,"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":1271.21,"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":1160.67,"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":1879.18,"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":1271.21,"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":1492.29,"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":1050.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4697.95,"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":4145.25,"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":514.01,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":718.51,"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":2763.50,"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":4421.60,"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":4697.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2763.50,"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":746.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8014.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1575.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2487.15,"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":1398.33,"methodology":"percent of total billed charges"}]}]},{"description":"SHUNT CV TEMP 2.75MM ","code_information":[{"code":"812974","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5502.00,"discounted_cash":5502.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":907.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":412.65,"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":1050.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":731.77,"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":990.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1375.50,"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":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1210.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":660.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2751.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"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":1331.48,"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":737.27,"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":588.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":291.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":269.60,"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":979.36,"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":1331.48,"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":979.36,"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":2751.00,"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":5502.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":770.28,"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":1215.94,"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":1094.90,"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":2751.00,"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":4401.60,"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":880.32,"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":511.69,"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":1265.46,"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":1155.42,"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":1870.68,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1265.46,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1045.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4676.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4126.50,"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":511.69,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":715.26,"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":2751.00,"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":4401.60,"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":4676.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2751.00,"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":742.77,"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":7977.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1568.07,"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":2475.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1392.01,"methodology":"percent of total billed charges"}]}]},{"description":"SHUNT CV TEMP 2MM ","code_information":[{"code":"812970","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5502.00,"discounted_cash":5502.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":907.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":412.65,"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":1050.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":731.77,"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":990.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1375.50,"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":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1210.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":660.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2751.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"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":1331.48,"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":737.27,"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":588.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":291.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":269.60,"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":979.36,"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":1331.48,"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":979.36,"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":2751.00,"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":5502.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":770.28,"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":1215.94,"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":1094.90,"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":2751.00,"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":4401.60,"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":880.32,"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":511.69,"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":1265.46,"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":1155.42,"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":1870.68,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1265.46,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1045.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4676.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4126.50,"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":511.69,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":715.26,"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":2751.00,"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":4401.60,"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":4676.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2751.00,"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":742.77,"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":7977.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1568.07,"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":2475.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1392.01,"methodology":"percent of total billed charges"}]}]},{"description":"SHUNT FLOCOIL 2.0 LONG ","code_information":[{"code":"812971","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5502.00,"discounted_cash":5502.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":907.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":412.65,"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":1050.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":731.77,"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":990.36,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1375.50,"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":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1210.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":660.24,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2751.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"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":1331.48,"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":737.27,"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":588.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":291.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":269.60,"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":979.36,"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":1331.48,"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":979.36,"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":2751.00,"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":5502.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":770.28,"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":1215.94,"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":1094.90,"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":2751.00,"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":4401.60,"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":880.32,"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":511.69,"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":1265.46,"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":1155.42,"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":1870.68,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1265.46,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1485.54,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1045.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":4676.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4126.50,"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":511.69,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":715.26,"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":2751.00,"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":4401.60,"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":4676.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2751.00,"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":742.77,"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":7977.90,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1568.07,"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":2475.90,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1392.01,"methodology":"percent of total billed charges"}]}]},{"description":"SI ENDO W/BPSY SNG/MULT ","code_information":[{"code":"790686","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":6072.00,"discounted_cash":6072.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":455.40,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1092.96,"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":1639.44,"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":1639.44,"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":1639.44,"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":1639.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3036.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1639.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1639.44,"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":1639.44,"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":1469.42,"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":813.65,"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":649.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":321.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":297.53,"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":1080.82,"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":1469.42,"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":1080.82,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3036.00,"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":6072.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":850.08,"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":3036.00,"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":4857.60,"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":971.52,"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":564.70,"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":1396.56,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1396.56,"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":1639.44,"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":1153.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5161.20,"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":4554.00,"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":564.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3036.00,"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":4857.60,"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":5161.20,"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":3036.00,"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":819.72,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8804.40,"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":2732.40,"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":1536.22,"methodology":"percent of total billed charges"}]}]},{"description":"SI ENDO W/PL JEJ TUBE ","code_information":[{"code":"117236","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":728.00,"discounted_cash":728.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":54.60,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":131.04,"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":196.56,"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":196.56,"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":196.56,"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":196.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":364.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":196.56,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":196.56,"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":196.56,"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":176.18,"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":97.55,"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":77.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":38.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":35.67,"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":129.58,"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":176.18,"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":129.58,"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":364.00,"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":728.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":101.92,"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":364.00,"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":582.40,"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":116.48,"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":67.70,"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":167.44,"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":167.44,"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":196.56,"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":138.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":618.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":546.00,"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":67.70,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":364.00,"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":582.40,"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":618.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":364.00,"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":98.28,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1055.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":327.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":184.18,"methodology":"percent of total billed charges"}]}]},{"description":"Sialolithotomy; parotid, extraoral or complicated intraoral ","code_information":[{"code":"42340","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sialolithotomy; submandibular (submaxillary), complicated, intraoral ","code_information":[{"code":"42335","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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sialolithotomy; submandibular (submaxillary), complicated, intraoral ","code_information":[{"code":"42335","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral ","code_information":[{"code":"369","type":"RC"},{"code":"42330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"45330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"45346","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) ","code_information":[{"code":"45350","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) ","code_information":[{"code":"45350","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with control of bleeding, any method ","code_information":[{"code":"45334","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with control of bleeding, any method ","code_information":[{"code":"45334","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ","code_information":[{"code":"45337","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ","code_information":[{"code":"45337","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with endoscopic mucosal resection ","code_information":[{"code":"45349","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"45347","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with removal of foreign body(s) ","code_information":[{"code":"45332","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with removal of foreign body(s) ","code_information":[{"code":"45332","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps ","code_information":[{"code":"369","type":"RC"},{"code":"45333","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps ","code_information":[{"code":"45333","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps ","code_information":[{"code":"45333","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ","code_information":[{"code":"45338","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) ","code_information":[{"code":"45342","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC ","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":418.00,"maximum":31622.54,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15434.81,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":15359.52,"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":12978.91,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":15510.10,"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":5080.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":15058.35,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":16331.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10424.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8683.13,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":15208.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15208.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11920.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16331.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11920.26,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11356.38,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":15058.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16564.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":18215.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":25901.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":14757.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15359.52,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":15058.35,"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":15359.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":17166.52,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":16865.35,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":15058.35,"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":14757.18,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":14757.18,"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":"Leon Health","plan_name":"MCR","standard_charge_dollar":14757.18,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15359.52,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"case rate"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":15058.35,"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":15961.85,"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":"NaphCare","plan_name":"Prison","standard_charge_dollar":31622.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18822.94,"methodology":"fee schedule"},{"payer_name":"Odyssey HealthCare","plan_name":"COMM","standard_charge_dollar":418.00,"methodology":"per diem"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9235.64,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":15058.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":15660.68,"methodology":"fee schedule"},{"payer_name":"Seasons Hospice","plan_name":"COMM","standard_charge_dollar":850.00,"methodology":"per diem"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":29363.78,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":15811.27,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":104.00,"standard_charge_algorithm":"Reimbursement will be 104% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":16564.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15208.93,"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":10400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7822 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":15058.35,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":14350.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10400.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7822 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":15058.35,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":15058.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14606.60,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":29363.78,"methodology":"fee schedule"}]}]},{"description":"SIM2 M 67025290 ","code_information":[{"code":"889383","type":"CDM"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":5365.00,"discounted_cash":5365.00,"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":885.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1024.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":713.54,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":965.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1341.25,"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":1448.55,"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":1448.55,"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":1448.55,"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":1448.55,"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":1180.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":643.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2682.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1448.55,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1448.55,"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":1448.55,"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":1298.33,"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":718.91,"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":574.05,"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":954.97,"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":1298.33,"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":954.97,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2682.50,"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":5365.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":751.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":1185.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":1067.63,"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":2682.50,"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":4292.00,"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":858.40,"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":498.95,"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":1233.95,"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":1126.65,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1824.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1233.95,"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":1448.55,"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":1019.35,"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":4560.25,"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":4023.75,"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":498.95,"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":697.45,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2682.50,"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":4292.00,"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":4560.25,"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":2682.50,"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":724.27,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":7779.25,"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":1529.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2414.25,"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":1357.35,"methodology":"percent of total billed charges"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm ","code_information":[{"code":"12016","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm ","code_information":[{"code":"12013","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm ","code_information":[{"code":"12014","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm ","code_information":[{"code":"12014","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm ","code_information":[{"code":"12014","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm ","code_information":[{"code":"12015","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm ","code_information":[{"code":"12018","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm ","code_information":[{"code":"12018","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm ","code_information":[{"code":"12004","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Simple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical uroflowmeter) ","code_information":[{"code":"369","type":"RC"},{"code":"51736","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY ","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":418.00,"maximum":145175.19,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":35202.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":51113.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":44619.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":28231.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":50864.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":49637.96,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":51363.06,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":16184.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":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":7982.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":49867.05,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":145175.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":49569.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":42290.00,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":50365.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":50365.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":50764.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":145175.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":50764.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":43432.57,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":49867.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":54853.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":50322.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":60253.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":48869.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":50864.39,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":49867.05,"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":50864.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":56848.44,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":55851.10,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":49867.05,"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":48869.71,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":48869.71,"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":"Leon Health","plan_name":"MCR","standard_charge_dollar":48869.71,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":50864.39,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":49867.05,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"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":52859.07,"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":"NaphCare","plan_name":"Prison","standard_charge_dollar":104720.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":62333.81,"methodology":"fee schedule"},{"payer_name":"Odyssey HealthCare","plan_name":"COMM","standard_charge_dollar":418.00,"methodology":"per diem"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":35321.79,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":49867.05,"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":51861.73,"methodology":"fee schedule"},{"payer_name":"Seasons Hospice","plan_name":"COMM","standard_charge_dollar":850.00,"methodology":"per diem"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":97240.75,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":52360.40,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":104.00,"standard_charge_algorithm":"Reimbursement will be 104% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":54853.76,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":50365.72,"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":95089.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":49867.05,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":47523.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":95089.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":49867.05,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":49867.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":48371.04,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":97240.75,"methodology":"fee schedule"}]}]},{"description":"Sinusotomy frontal; external, simple (trephine operation) ","code_information":[{"code":"31070","type":"CPT"},{"code":"481","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":6926.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; external, simple (trephine operation) ","code_information":[{"code":"31070","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":6926.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; nonobliterative, with osteoplastic flap, brow incision ","code_information":[{"code":"31086","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; nonobliterative, with osteoplastic flap, coronal incision ","code_information":[{"code":"31087","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; obliterative without osteoplastic flap, brow incision (includes ablation) ","code_information":[{"code":"31080","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; obliterative without osteoplastic flap, brow incision (includes ablation) ","code_information":[{"code":"31080","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; obliterative, without osteoplastic flap, coronal incision (includes ablation) ","code_information":[{"code":"31081","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; obliterative, without osteoplastic flap, coronal incision (includes ablation) ","code_information":[{"code":"31081","type":"CPT"},{"code":"790","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; transorbital, unilateral (for mucocele or osteoma, Lynch type) ","code_information":[{"code":"31075","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy, maxillary (antrotomy); intranasal ","code_information":[{"code":"31020","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy, maxillary (antrotomy); intranasal ","code_information":[{"code":"31020","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy, maxillary (antrotomy); intranasal ","code_information":[{"code":"31020","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) with removal of antrochoanal polyps ","code_information":[{"code":"31032","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy, sphenoid, with or without biopsy; ","code_information":[{"code":"31050","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy, sphenoid, with or without biopsy; ","code_information":[{"code":"31050","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp(s) ","code_information":[{"code":"31051","type":"CPT"},{"code":"790","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy, unilateral, 3 or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid) ","code_information":[{"code":"31090","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case 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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy, unilateral, 3 or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid) ","code_information":[{"code":"31090","type":"CPT"},{"code":"499","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":6926.00,"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":11053.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11053.00,"methodology":"case rate"}]}]},{"description":"SIZER BREAST 270CC ","code_information":[{"code":"803638","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1041.00,"discounted_cash":1041.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":171.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":78.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":198.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":138.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":187.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":260.25,"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":281.07,"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":281.07,"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":281.07,"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":281.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":229.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":124.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":520.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":281.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":281.07,"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":281.07,"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":251.92,"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":139.49,"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":111.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":55.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":51.01,"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":185.30,"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":251.92,"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":185.30,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":520.50,"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":1041.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":145.74,"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":230.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":207.16,"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":520.50,"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":832.80,"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":166.56,"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":96.81,"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":239.43,"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":218.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":353.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":239.43,"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":281.07,"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":197.79,"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":884.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":780.75,"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":96.81,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":135.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":520.50,"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":832.80,"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":884.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":520.50,"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":140.53,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1509.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":296.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":468.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":263.37,"methodology":"percent of total billed charges"}]}]},{"description":"SIZER BREAST 420CC ","code_information":[{"code":"804088","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1615.00,"discounted_cash":1615.00,"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":266.48,"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":121.13,"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":308.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":214.79,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":290.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":403.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":436.05,"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":436.05,"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":436.05,"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":436.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":355.30,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":193.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":807.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":436.05,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":436.05,"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":436.05,"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":390.83,"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":216.41,"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":172.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":85.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":79.14,"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":287.47,"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":390.83,"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":287.47,"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":807.50,"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":1615.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":226.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":356.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":321.38,"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":807.50,"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":1292.00,"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":258.40,"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":150.20,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":371.45,"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":339.15,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":549.10,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":371.45,"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":436.05,"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":306.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1372.75,"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":1211.25,"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":150.20,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":209.95,"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":807.50,"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":1292.00,"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":1372.75,"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":807.50,"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":218.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2341.75,"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":460.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":726.75,"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":408.60,"methodology":"percent of total billed charges"}]}]},{"description":"SIZER VASC GRFT 24-38MM ","code_information":[{"code":"906918","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2469.00,"discounted_cash":2469.00,"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":407.38,"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":185.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":471.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":328.38,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":444.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":617.25,"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":666.63,"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":666.63,"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":666.63,"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":666.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":543.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":296.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1234.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":666.63,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":666.63,"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":666.63,"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":597.50,"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":330.85,"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":264.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":130.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":120.98,"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":439.48,"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":597.50,"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":439.48,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1234.50,"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":2469.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":345.66,"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":545.65,"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":491.33,"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":1234.50,"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":1975.20,"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":395.04,"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":229.62,"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":567.87,"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":518.49,"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":839.46,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":567.87,"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":666.63,"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":469.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2098.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1851.75,"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":229.62,"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":320.97,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1234.50,"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":1975.20,"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":2098.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1234.50,"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":333.31,"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":3580.05,"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":703.66,"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":1111.05,"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":624.66,"methodology":"percent of total billed charges"}]}]},{"description":"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC ","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":418.00,"maximum":124096.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":60571.00,"methodology":"fee schedule"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":60275.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 13+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":59355.03,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":60866.47,"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":7982.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":59093.66,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_dollar":5379.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":68146.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":43499.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":36232.91,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":59684.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":59684.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":49740.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":68146.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":49740.78,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":51934.89,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":59093.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":65003.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":83302.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":118451.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":57911.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":60275.53,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":59093.66,"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":60275.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":67366.77,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":66184.90,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":59093.66,"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":57911.79,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":57911.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":57911.79,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":60275.53,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":59093.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"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":62639.28,"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":"NaphCare","plan_name":"Prison","standard_charge_dollar":124096.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":73867.08,"methodology":"fee schedule"},{"payer_name":"Odyssey HealthCare","plan_name":"COMM","standard_charge_dollar":418.00,"methodology":"per diem"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":42236.35,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":59093.66,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":61457.41,"methodology":"fee schedule"},{"payer_name":"Seasons Hospice","plan_name":"COMM","standard_charge_dollar":850.00,"methodology":"per diem"},{"payer_name":"Seven Corners","plan_name":"Prison","standard_charge_dollar":115232.64,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":62048.34,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":104.00,"standard_charge_algorithm":"Reimbursement will be 104% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":65003.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":59684.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10840.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7822 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":59093.66,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":56316.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10840.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7822 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":59093.66,"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":59093.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":57320.85,"methodology":"fee schedule"},{"payer_name":"Wellpath ","plan_name":"MCR","standard_charge_dollar":115232.64,"methodology":"fee schedule"}]}]},{"description":"SLEEVE CMPR FNGR XL ","code_information":[{"code":"858338","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1695.00,"discounted_cash":1695.00,"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":279.68,"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":127.13,"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":323.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":225.44,"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":305.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":423.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":457.65,"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":457.65,"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":457.65,"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":457.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":372.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":203.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":847.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":457.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":457.65,"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":457.65,"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":410.19,"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":227.13,"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":181.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":89.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":83.06,"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":301.71,"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":410.19,"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":301.71,"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":847.50,"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":1695.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":237.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":374.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":337.31,"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":847.50,"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":1356.00,"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":271.20,"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":157.64,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":389.85,"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":355.95,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":576.30,"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":389.85,"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":457.65,"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":322.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1440.75,"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":1271.25,"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":157.64,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":220.35,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":847.50,"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":1356.00,"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":1440.75,"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":847.50,"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":228.82,"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":2457.75,"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":483.07,"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":762.75,"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":428.83,"methodology":"percent of total billed charges"}]}]},{"description":"SLEEVE DRILL 100MM ","code_information":[{"code":"847295","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"SLEEVE IRRIGATION 7CM ","code_information":[{"code":"901768","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"SLING ARM SMALL ","code_information":[{"code":"832752","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":47.00,"discounted_cash":47.00,"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":7.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":3.52,"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":8.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":6.25,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":8.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":11.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.69,"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":12.69,"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":12.69,"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":12.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":10.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":5.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.69,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":12.69,"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":12.69,"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":11.37,"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":6.30,"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":5.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":2.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":2.30,"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":8.37,"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":11.37,"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":8.37,"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":23.50,"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":47.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":6.58,"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":10.39,"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":9.35,"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":23.50,"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":37.60,"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":7.52,"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":4.37,"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":10.81,"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":9.87,"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":15.98,"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":10.81,"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":12.69,"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":8.93,"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":39.95,"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":35.25,"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":4.37,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":6.11,"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":23.50,"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":37.60,"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":39.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":23.50,"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":6.34,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":68.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":13.39,"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":21.15,"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":11.89,"methodology":"percent of total billed charges"}]}]},{"description":"Sling operation for correction of male urinary incontinence (eg, fascia or synthetic) ","code_information":[{"code":"369","type":"RC"},{"code":"53440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"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":7571.00,"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":"Molina","plan_name":"HIX","standard_charge_dollar":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":11895.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15136.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15136.00,"methodology":"case rate"}]}]},{"description":"Sling operation for stress incontinence (eg, fascia or synthetic) ","code_information":[{"code":"57288","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":12077.00,"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":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15136.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15136.00,"methodology":"case rate"}]}]},{"description":"Sling operation for stress incontinence (eg, fascia or synthetic) ","code_information":[{"code":"57288","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":11299.00,"methodology":"case rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"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":15136.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":15136.00,"methodology":"case rate"}]}]},{"description":"SLINGSHOT HIP SCPE UP 45 ","code_information":[{"code":"917553","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3701.00,"discounted_cash":3701.00,"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":610.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":277.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":706.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":492.23,"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":666.18,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":925.25,"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":999.27,"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":999.27,"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":999.27,"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":999.27,"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":814.22,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":444.12,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1850.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999.27,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":999.27,"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":999.27,"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":895.64,"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":495.93,"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":396.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":196.15,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":181.35,"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":658.78,"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":895.64,"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":658.78,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1850.50,"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":3701.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":518.14,"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":817.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":736.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1850.50,"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":2960.80,"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":592.16,"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":344.19,"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":851.23,"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":777.21,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1258.34,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":851.23,"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":999.27,"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":703.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":3145.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2775.75,"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":344.19,"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":481.13,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1850.50,"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":2960.80,"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":3145.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1850.50,"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":499.63,"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":5366.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1054.79,"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":1665.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":936.35,"methodology":"percent of total billed charges"}]}]},{"description":"Slitting of prepuce, dorsal or lateral (separate procedure); except newborn ","code_information":[{"code":"54001","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Slitting of prepuce, dorsal or lateral (separate procedure); newborn ","code_information":[{"code":"360","type":"RC"},{"code":"54000","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Slitting of prepuce, dorsal or lateral (separate procedure); newborn ","code_information":[{"code":"369","type":"RC"},{"code":"54000","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with biopsy, single or multiple ","code_information":[{"code":"44377","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and c ","code_information":[{"code":"499","type":"RC"},{"code":"C5273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition ","code_information":[{"code":"360","type":"RC"},{"code":"C5272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequ ","code_information":[{"code":"20696","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":13594.00,"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":13594.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Application of rigid total contact leg cast ","code_information":[{"code":"29445","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of rigid total contact leg cast ","code_information":[{"code":"29445","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of Risser jacket, localizer, body; including head ","code_information":[{"code":"29015","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of Risser jacket, localizer, body; including head ","code_information":[{"code":"29015","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of Risser jacket, localizer, body; only ","code_information":[{"code":"29010","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of Risser jacket, localizer, body; only ","code_information":[{"code":"29010","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of short arm splint (forearm to hand); dynamic ","code_information":[{"code":"29126","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of short arm splint (forearm to hand); static ","code_information":[{"code":"29125","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of short arm splint (forearm to hand); static ","code_information":[{"code":"29125","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of short leg cast (below knee to toes); ","code_information":[{"code":"29405","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of short leg cast (below knee to toes); ","code_information":[{"code":"29405","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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq ","code_information":[{"code":"15276","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq ","code_information":[{"code":"15276","type":"CPT"},{"code":"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or les ","code_information":[{"code":"15275","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or les ","code_information":[{"code":"15275","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or les ","code_information":[{"code":"15275","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or les ","code_information":[{"code":"15275","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children ","code_information":[{"code":"15273","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children ","code_information":[{"code":"15273","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), UNLESS OTHERWISE LISTED; SINGLE LESION ","code_information":[{"code":"11100","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":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":"BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), UNLESS OTHERWISE LISTED; SINGLE LESION ","code_information":[{"code":"11100","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":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"}]}]},{"description":"Biopsy of stomach, by laparotomy ","code_information":[{"code":"361","type":"RC"},{"code":"43605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy of stomach, by laparotomy ","code_information":[{"code":"43605","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":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy of testis, incisional (separate procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"54505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy of testis, incisional (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"54505","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy of tongue; posterior one-third ","code_information":[{"code":"360","type":"RC"},{"code":"41105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vaginal mucosa; extensive, requiring suture (including cysts) ","code_information":[{"code":"369","type":"RC"},{"code":"57105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vaginal mucosa; extensive, requiring suture (including cysts) ","code_information":[{"code":"481","type":"RC"},{"code":"57105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); 1 lesion ","code_information":[{"code":"56605","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"56606","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"56606","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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) ","code_information":[{"code":"56606","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) ","code_information":[{"code":"56606","type":"CPT"},{"code":"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary) ","code_information":[{"code":"369","type":"RC"},{"code":"38505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary) ","code_information":[{"code":"38505","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep axillary node(s) ","code_information":[{"code":"369","type":"RC"},{"code":"38525","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 rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) ","code_information":[{"code":"361","type":"RC"},{"code":"38510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":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 rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad ","code_information":[{"code":"369","type":"RC"},{"code":"38520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":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 rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad ","code_information":[{"code":"38520","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":13320.00,"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 rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad ","code_information":[{"code":"38520","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":17832.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":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 rate"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13320.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":16049.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":17832.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, internal mammary node(s) ","code_information":[{"code":"361","type":"RC"},{"code":"38530","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":"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy or excision of lymph node(s); open, internal mammary node(s) ","code_information":[{"code":"38530","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"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":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx) ","code_information":[{"code":"20240","type":"CPT"},{"code":"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx) ","code_information":[{"code":"20240","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur) ","code_information":[{"code":"20225","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, i ","code_information":[{"code":"19082","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, i ","code_information":[{"code":"19084","type":"CPT"},{"code":"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, i ","code_information":[{"code":"19084","type":"CPT"},{"code":"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, i ","code_information":[{"code":"19084","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including m ","code_information":[{"code":"19085","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including m ","code_information":[{"code":"19085","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including m ","code_information":[{"code":"19085","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including m ","code_information":[{"code":"19085","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including s ","code_information":[{"code":"19081","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including s ","code_information":[{"code":"19081","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including u ","code_information":[{"code":"19083","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including u ","code_information":[{"code":"19083","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, intranasal ","code_information":[{"code":"30100","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, intranasal ","code_information":[{"code":"30100","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle, percutaneous needle ","code_information":[{"code":"20206","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle, percutaneous needle ","code_information":[{"code":"20206","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle, percutaneous needle ","code_information":[{"code":"20206","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle, percutaneous needle ","code_information":[{"code":"20206","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle, percutaneous needle ","code_information":[{"code":"20206","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, muscle; deep ","code_information":[{"code":"20205","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, pleura, percutaneous needle ","code_information":[{"code":"32400","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, pleura, percutaneous needle ","code_information":[{"code":"32400","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, prostate; incisional, any approach ","code_information":[{"code":"369","type":"RC"},{"code":"55705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, prostate; incisional, any approach ","code_information":[{"code":"481","type":"RC"},{"code":"55705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, prostate; needle or punch, single or multiple, any approach ","code_information":[{"code":"499","type":"RC"},{"code":"55700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; deep ","code_information":[{"code":"21925","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; deep ","code_information":[{"code":"21925","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of back or flank; deep ","code_information":[{"code":"21925","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":2580.00,"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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular) ","code_information":[{"code":"25066","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular) ","code_information":[{"code":"25066","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular) ","code_information":[{"code":"27614","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; superficial ","code_information":[{"code":"27613","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of neck or thorax ","code_information":[{"code":"21550","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":2580.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of pelvis and hip area; superficial ","code_information":[{"code":"27040","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3740.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of shoulder area; deep ","code_information":[{"code":"23066","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of shoulder area; deep ","code_information":[{"code":"23066","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular) ","code_information":[{"code":"27324","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of thigh or knee area; superficial ","code_information":[{"code":"27323","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3740.00,"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":2580.00,"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":3740.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3740.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular) ","code_information":[{"code":"24066","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, soft tissue of upper arm or elbow area; superficial ","code_information":[{"code":"24065","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5193.00,"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":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vertebral body, open; lumbar or cervical ","code_information":[{"code":"20251","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":7571.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vertebral body, open; lumbar or cervical ","code_information":[{"code":"20251","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":7571.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vertebral body, open; thoracic ","code_information":[{"code":"20250","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vertebral body, open; thoracic ","code_information":[{"code":"20250","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9587.00,"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":9587.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9587.00,"methodology":"case rate"}]}]},{"description":"Biopsy, vestibule of mouth ","code_information":[{"code":"360","type":"RC"},{"code":"40808","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":2580.00,"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":1956.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":1956.00,"methodology":"case rate"}]}]},{"description":"Biopsy; nasopharynx, survey for unknown primary lesion ","code_information":[{"code":"42806","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":6990.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":6990.00,"methodology":"case rate"}]}]},{"description":"Biopsy; nasopharynx, visible lesion, simple ","code_information":[{"code":"369","type":"RC"},{"code":"42804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"Biopsy; nasopharynx, visible lesion, simple ","code_information":[{"code":"42804","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5193.00,"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":5193.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5193.00,"methodology":"case rate"}]}]},{"description":"BIT CNTRSNK DRL 1.3 MM 1 ","code_information":[{"code":"836808","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2387.00,"discounted_cash":2387.00,"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":393.86,"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":179.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":455.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":317.47,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":429.66,"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":596.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":644.49,"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":644.49,"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":644.49,"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":644.49,"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":525.14,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":286.44,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1193.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":644.49,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":644.49,"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":644.49,"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":577.65,"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":319.86,"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":255.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":126.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":116.96,"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":424.89,"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":577.65,"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":424.89,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1193.50,"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":2387.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":334.18,"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":527.53,"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":475.01,"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":1193.50,"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":1909.60,"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":381.92,"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":221.99,"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":549.01,"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":501.27,"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":811.58,"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":549.01,"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":644.49,"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":453.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2028.95,"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":1790.25,"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":221.99,"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":310.31,"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":1193.50,"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":1909.60,"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":2028.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1193.50,"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":322.25,"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":3461.15,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":680.29,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1074.15,"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":603.91,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRIL 1X54 12 STP ","code_information":[{"code":"868701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 1.4MM 77MM ","code_information":[{"code":"851749","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2189.00,"discounted_cash":2189.00,"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":361.19,"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":164.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":418.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":291.14,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":394.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":547.25,"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":591.03,"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":591.03,"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":591.03,"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":591.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":481.58,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":262.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1094.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":591.03,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":591.03,"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":591.03,"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":529.74,"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":293.33,"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":234.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":116.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":107.26,"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":389.64,"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":529.74,"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":389.64,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1094.50,"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":2189.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":306.46,"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":483.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":435.61,"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":1094.50,"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":1751.20,"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":350.24,"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":203.58,"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":503.47,"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":459.69,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":744.26,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":503.47,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":591.03,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":415.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1860.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1641.75,"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":203.58,"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":284.57,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1094.50,"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":1751.20,"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":1860.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1094.50,"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":295.51,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3174.05,"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":623.87,"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":985.05,"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":553.82,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 1.5MM ","code_information":[{"code":"920160","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 1.6MM 19MM ","code_information":[{"code":"941500","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 1.6MM 2.4MM ","code_information":[{"code":"896494","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 1.7MM ","code_information":[{"code":"803855","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 1.9MM 2.5MM ","code_information":[{"code":"920317","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 145X4.5MM BIDR ","code_information":[{"code":"805861","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2.1MM ","code_information":[{"code":"857042","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2.3MM ","code_information":[{"code":"911661","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":897.00,"discounted_cash":897.00,"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":148.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":67.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":171.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":119.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":161.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":224.25,"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":242.19,"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":242.19,"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":242.19,"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":242.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":197.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":107.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":242.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":242.19,"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":242.19,"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":217.07,"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":120.20,"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":95.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":47.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":43.95,"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":159.67,"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":217.07,"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":159.67,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":897.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":125.58,"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":198.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":178.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":717.60,"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":143.52,"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":83.42,"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":206.31,"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":188.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":304.98,"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":206.31,"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":242.19,"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":170.43,"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":762.45,"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":672.75,"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":83.42,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":116.61,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":717.60,"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":762.45,"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":448.50,"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":121.09,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1300.65,"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":255.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":403.65,"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":226.94,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2.3MM 20MM ","code_information":[{"code":"838736","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2297.00,"discounted_cash":2297.00,"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":379.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":172.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":438.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":305.50,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":413.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":574.25,"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":620.19,"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":620.19,"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":620.19,"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":620.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":505.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":275.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1148.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":620.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":620.19,"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":620.19,"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":555.87,"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":307.80,"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":245.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":121.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":112.55,"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":408.87,"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":555.87,"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":408.87,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1148.50,"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":2297.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":321.58,"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":507.64,"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":457.10,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1148.50,"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":1837.60,"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":367.52,"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":213.62,"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":528.31,"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":482.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":780.98,"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":528.31,"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":620.19,"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":436.43,"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":1952.45,"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":1722.75,"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":213.62,"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":298.61,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1148.50,"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":1837.60,"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":1952.45,"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":1148.50,"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":310.10,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3330.65,"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":654.64,"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":1033.65,"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":581.14,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2.5X245MM ","code_information":[{"code":"919642","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2595.00,"discounted_cash":2595.00,"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":428.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":194.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":495.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":345.13,"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":467.10,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":648.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":700.65,"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":700.65,"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":700.65,"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":700.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":570.90,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":311.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1297.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":700.65,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":700.65,"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":700.65,"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":627.99,"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":347.73,"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":277.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":137.53,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":127.16,"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":461.91,"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":627.99,"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":461.91,"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":1297.50,"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":2595.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":363.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":573.50,"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":516.40,"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":1297.50,"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":2076.00,"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":415.20,"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":241.34,"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":596.85,"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":544.95,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":882.30,"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":596.85,"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":700.65,"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":493.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2205.75,"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":1946.25,"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":241.34,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":337.35,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1297.50,"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":2076.00,"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":2205.75,"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":1297.50,"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":350.32,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3762.75,"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":739.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1167.75,"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":656.53,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2.6MM ","code_information":[{"code":"803205","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2.7MM CANN ","code_information":[{"code":"848087","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":897.00,"discounted_cash":897.00,"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":148.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":67.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":171.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":119.30,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":161.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":224.25,"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":242.19,"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":242.19,"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":242.19,"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":242.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":197.34,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":107.64,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":242.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":242.19,"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":242.19,"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":217.07,"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":120.20,"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":95.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":47.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":43.95,"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":159.67,"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":217.07,"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":159.67,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":897.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":125.58,"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":198.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":178.50,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":717.60,"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":143.52,"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":83.42,"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":206.31,"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":188.37,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":304.98,"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":206.31,"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":242.19,"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":170.43,"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":762.45,"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":672.75,"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":83.42,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":116.61,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":448.50,"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":717.60,"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":762.45,"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":448.50,"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":121.09,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1300.65,"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":255.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":403.65,"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":226.94,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 2MM ","code_information":[{"code":"805694","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1193.00,"discounted_cash":1193.00,"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":196.84,"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":89.47,"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":227.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":158.67,"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":214.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":298.25,"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":322.11,"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":322.11,"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":322.11,"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":322.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":262.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":143.16,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":596.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":322.11,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":322.11,"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":322.11,"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":288.71,"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":159.86,"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":127.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":63.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":58.46,"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":212.35,"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":288.71,"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":212.35,"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":596.50,"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":1193.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":167.02,"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":263.65,"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":237.41,"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":596.50,"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":954.40,"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":190.88,"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":110.95,"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":274.39,"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":250.53,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":405.62,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":274.39,"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":322.11,"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":226.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1014.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":894.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":110.95,"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":155.09,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":596.50,"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":954.40,"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":1014.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":596.50,"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":161.06,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":1729.85,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":340.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":536.85,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":301.83,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 3.2MM 200MM ","code_information":[{"code":"808161","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 3.3MM 245MM ","code_information":[{"code":"892145","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 340MM 4.2MM ","code_information":[{"code":"801712","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 3MM 3.8MM ","code_information":[{"code":"850044","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2635.00,"discounted_cash":2635.00,"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":434.77,"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":197.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":503.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":350.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":474.30,"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":658.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":711.45,"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":711.45,"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":711.45,"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":711.45,"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":579.70,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":316.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1317.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":711.45,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":711.45,"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":711.45,"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":637.67,"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":353.09,"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":281.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":139.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":129.12,"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":469.03,"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":637.67,"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":469.03,"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":1317.50,"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":2635.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":368.90,"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":582.34,"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":524.36,"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":1317.50,"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":2108.00,"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":421.60,"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":245.06,"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":606.05,"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":553.35,"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":895.90,"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":606.05,"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":711.45,"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":500.65,"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":2239.75,"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":1976.25,"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":245.06,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":342.55,"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":1317.50,"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":2108.00,"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":2239.75,"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":1317.50,"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":355.73,"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":3820.75,"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":750.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1185.75,"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":666.65,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 4.2X230MM ","code_information":[{"code":"801715","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 4.3MM 152MM ","code_information":[{"code":"839023","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 4MM ","code_information":[{"code":"920190","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3780.00,"discounted_cash":3780.00,"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":623.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":283.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":721.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":502.74,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":680.40,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":945.00,"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":1020.60,"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":1020.60,"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":1020.60,"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":1020.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":831.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":453.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1890.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1020.60,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1020.60,"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":1020.60,"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":914.76,"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":506.52,"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":404.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":200.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":185.22,"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":672.84,"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":914.76,"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":672.84,"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":1890.00,"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":3780.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":529.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":835.38,"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":752.22,"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":1890.00,"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":3024.00,"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":604.80,"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":351.54,"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":869.40,"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":793.80,"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":1285.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":869.40,"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":1020.60,"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":718.20,"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":3213.00,"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":2835.00,"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":351.54,"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":491.40,"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":1890.00,"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":3024.00,"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":3213.00,"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":1890.00,"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":510.30,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":5481.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1077.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1701.00,"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":956.34,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 4MM 180MM ","code_information":[{"code":"801710","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 50 1.1 7 STP ","code_information":[{"code":"937767","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"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":238.45,"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":589.72,"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":538.44,"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":871.76,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":589.72,"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":692.28,"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":487.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1923.00,"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":238.45,"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":333.32,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":2051.20,"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":2179.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"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":346.14,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3717.80,"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":730.74,"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":1153.80,"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":648.69,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL 6MM ","code_information":[{"code":"852772","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5941.00,"discounted_cash":5941.00,"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":980.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":445.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":1134.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":790.15,"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":1069.38,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":1485.25,"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":1604.07,"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":1604.07,"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":1604.07,"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":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":1307.02,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":712.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1604.07,"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":1604.07,"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":1437.72,"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":796.09,"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":635.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":314.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":291.11,"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":1057.50,"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":1437.72,"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":1057.50,"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":2970.50,"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":5941.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":831.74,"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":1312.96,"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":1182.26,"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":2970.50,"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":4752.80,"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":950.56,"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":552.51,"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":1366.43,"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":1247.61,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":2019.94,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1366.43,"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":1604.07,"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":1128.79,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4455.75,"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":552.51,"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":772.33,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":4752.80,"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":5049.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2970.50,"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":802.03,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":8614.45,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":1693.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2673.45,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1503.07,"methodology":"percent of total billed charges"}]}]},{"description":"BIT DRILL BIT 4.0MM CALI ","code_information":[{"code":"880799","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2564.00,"discounted_cash":2564.00,"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":423.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":192.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":489.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":13.30,"standard_charge_algorithm":"Reimbursement will be 13.3% of billable gross charges.","estimated_amount":341.01,"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":461.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":641.00,"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":692.28,"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":692.28,"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":692.28,"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":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":564.08,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":307.68,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1282.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelect","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":692.28,"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":692.28,"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":620.49,"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":343.58,"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":274.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":5.30,"standard_charge_algorithm":"Reimbursement will be 5.3% of billable gross charges.","estimated_amount":135.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":4.90,"standard_charge_algorithm":"Reimbursement will be 4.9% of billable gross charges.","estimated_amount":125.64,"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":456.39,"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":620.49,"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":456.39,"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":1282.00,"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":2564.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":358.96,"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":566.64,"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":510.24,"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":1282.00,"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":2051.20,"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":410.24,"methodology":"percen